Provider Demographics
NPI:1497796478
Name:SUN, YAN QUN (MD)
Entity Type:Individual
Prefix:DR
First Name:YAN
Middle Name:QUN
Last Name:SUN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 826
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-0826
Mailing Address - Country:US
Mailing Address - Phone:718-321-4205
Mailing Address - Fax:
Practice Address - Street 1:3830 PARSONS BLVD STE 1B
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-5841
Practice Address - Country:US
Practice Address - Phone:718-521-4206
Practice Address - Fax:718-321-1442
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2019-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY220000207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02287245Medicaid
NY473F21OtherEMPIRE BC.BS
NY7618332OtherAETNA
NYH75235Medicare UPIN
NY7618332OtherAETNA