Provider Demographics
NPI:1952663718
Name:SUN, LI (DO)
Entity Type:Individual
Prefix:
First Name:LI
Middle Name:
Last Name:SUN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 ROUTE 34 STE A
Mailing Address - Street 2:
Mailing Address - City:MATAWAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07747-2197
Mailing Address - Country:US
Mailing Address - Phone:732-812-3000
Mailing Address - Fax:
Practice Address - Street 1:1039 AVENUE C
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-3217
Practice Address - Country:US
Practice Address - Phone:201-972-5568
Practice Address - Fax:669-204-0326
Is Sole Proprietor?:No
Enumeration Date:2012-06-07
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB10331900207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery