Provider Demographics
NPI:1821082165
Name:SUN, JOHN (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:SUN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11609 SPRING CYPRESS RD STE A
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77377-8917
Mailing Address - Country:US
Mailing Address - Phone:281-357-8588
Mailing Address - Fax:281-357-8877
Practice Address - Street 1:11609 SPRING CYPRESS RD STE A
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77377-8917
Practice Address - Country:US
Practice Address - Phone:281-357-8588
Practice Address - Fax:281-357-8877
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-01
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK9912207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX038412504Medicaid
TX8F8911Medicare PIN
TX038412504Medicaid