Provider Demographics
NPI:1790098705
Name:SUN, XIAOYIN (OD)
Entity Type:Individual
Prefix:
First Name:XIAOYIN
Middle Name:
Last Name:SUN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 MARKET ST STE 402
Mailing Address - Street 2:
Mailing Address - City:PLAINSBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08536-2080
Mailing Address - Country:US
Mailing Address - Phone:609-799-1219
Mailing Address - Fax:609-799-1235
Practice Address - Street 1:6 MARKET ST
Practice Address - Street 2:SUITE 920
Practice Address - City:PLAINSBORO
Practice Address - State:NJ
Practice Address - Zip Code:08536-2096
Practice Address - Country:US
Practice Address - Phone:609-799-1219
Practice Address - Fax:609-799-1235
Is Sole Proprietor?:No
Enumeration Date:2010-07-19
Last Update Date:2018-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00626100152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1790098705OtherNATIONAL PROVIDER IDENTIFIER