Provider Demographics
NPI:1487640470
Name:SUN, ANDREW D (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:D
Last Name:SUN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 6406
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93456-6406
Mailing Address - Country:US
Mailing Address - Phone:805-928-1731
Mailing Address - Fax:805-349-8160
Practice Address - Street 1:345 S HALCYON RD
Practice Address - Street 2:
Practice Address - City:ARROYO GRANDE
Practice Address - State:CA
Practice Address - Zip Code:93420-3896
Practice Address - Country:US
Practice Address - Phone:805-928-1731
Practice Address - Fax:805-349-8160
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2007-09-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG62329207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G623290Medicaid
CA00G623290Medicaid
CAWG62329BMedicare PIN