Provider Demographics
NPI:1578744041
Name:SUN, LYDIA LIJUAN (MD)
Entity Type:Individual
Prefix:DR
First Name:LYDIA
Middle Name:LIJUAN
Last Name:SUN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LIJUAN
Other - Middle Name:
Other - Last Name:SUN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3131 PRINCETON PIKE
Mailing Address - Street 2:BLDG #4, SUITE 206
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-2201
Mailing Address - Country:US
Mailing Address - Phone:609-895-1230
Mailing Address - Fax:609-755-0157
Practice Address - Street 1:3131 PRINCETON PIKE
Practice Address - Street 2:BLDG #4, SUITE 206
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648-2201
Practice Address - Country:US
Practice Address - Phone:609-895-1230
Practice Address - Fax:609-755-0157
Is Sole Proprietor?:No
Enumeration Date:2007-11-26
Last Update Date:2010-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA72880207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ057707Q9YMedicare PIN
NJH60376Medicare UPIN