Provider Demographics
NPI:1558644815
Name:SUN, LI
Entity Type:Individual
Prefix:MR
First Name:LI
Middle Name:
Last Name:SUN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3403 HIGHWOOD CT., #157
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93063
Mailing Address - Country:US
Mailing Address - Phone:805-520-0876
Mailing Address - Fax:
Practice Address - Street 1:3403 HIGHWOOD CT APT 157
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93063-5313
Practice Address - Country:US
Practice Address - Phone:805-520-0876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-23
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC14006171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist