Provider Demographics
NPI:1619931805
Name:SUN, IRENE L (PSY D)
Entity Type:Individual
Prefix:DR
First Name:IRENE
Middle Name:L
Last Name:SUN
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7132 NIMROD DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-6222
Mailing Address - Country:US
Mailing Address - Phone:714-841-7437
Mailing Address - Fax:714-841-7437
Practice Address - Street 1:17610 BEACH BLVD.
Practice Address - Street 2:STE. 26
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-6960
Practice Address - Country:US
Practice Address - Phone:714-841-7437
Practice Address - Fax:714-841-7437
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 9948103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical