Provider Demographics
NPI:1760727689
Name:SUN, JIAXIANG
Entity Type:Individual
Prefix:MR
First Name:JIAXIANG
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 1:4335 UNION ST APT 2G
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-3013
Mailing Address - Country:US
Mailing Address - Phone:917-325-6510
Mailing Address - Fax:
Practice Address - Street 1:4335 UNION STREET
Practice Address - Street 2:2G
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-3045
Practice Address - Country:US
Practice Address - Phone:917-325-6510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-04
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002165171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist