Provider Demographics
NPI:1831132323
Name:SUN, JOSEPH L (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:L
Last Name:SUN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 E OSBORN RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2349
Mailing Address - Country:US
Mailing Address - Phone:602-264-1180
Mailing Address - Fax:602-264-1277
Practice Address - Street 1:255 E OSBORN RD
Practice Address - Street 2:SUITE 101
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-2349
Practice Address - Country:US
Practice Address - Phone:602-264-1180
Practice Address - Fax:602-264-1277
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ13849174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ51634OtherAETNA
AZ77200OtherPACIFICARE
AZ226507OtherACHS
AZ226507Medicaid
AZAZ0050910OtherBLUE CROSS OF ARIZONA
AZ1083702OtherCIGNA
AZ1Z8069OtherHEALTHNET
AZ51634OtherAETNA