Provider Demographics
NPI:1922592211
Name:SUN, MENGXUE
Entity Type:Individual
Prefix:
First Name:MENGXUE
Middle Name:
Last Name:SUN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:FIONA
Other - Middle Name:
Other - Last Name:SUN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:955 CRANBROOK CT APT 203
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-1255
Mailing Address - Country:US
Mailing Address - Phone:909-979-7812
Mailing Address - Fax:
Practice Address - Street 1:955 CRANBROOK CT APT 203
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-1255
Practice Address - Country:US
Practice Address - Phone:909-979-7812
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-19
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician