Provider Demographics
NPI:1619104270
Name:SUN, JIWU (MD)
Entity Type:Individual
Prefix:
First Name:JIWU
Middle Name:
Last Name:SUN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JIWU
Other - Middle Name:
Other - Last Name:SUN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1902 ROCK ST
Mailing Address - Street 2:APT A
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94043-2567
Mailing Address - Country:US
Mailing Address - Phone:831-636-5711
Mailing Address - Fax:
Practice Address - Street 1:1902 ROCK ST
Practice Address - Street 2:APT A
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94043-2567
Practice Address - Country:US
Practice Address - Phone:831-636-5711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-22
Last Update Date:2018-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA106681207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine