Provider Demographics
NPI:1710138045
Name:SUN, VANESSA (MD)
Entity Type:Individual
Prefix:MS
First Name:VANESSA
Middle Name:
Last Name:SUN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1240 N MISSION RD
Mailing Address - Street 2:OFFICE OF EDUCATION
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-1019
Mailing Address - Country:US
Mailing Address - Phone:323-226-3309
Mailing Address - Fax:
Practice Address - Street 1:1240 N MISSION RD
Practice Address - Street 2:OFFICE OF EDUCATION
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-1019
Practice Address - Country:US
Practice Address - Phone:323-226-3309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-06
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA103327207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology