Provider Demographics
NPI:1023332350
Name:SUN, CHUN-XIAO (DMD,MS,MSD,PHD)
Entity type:Individual
Prefix:DR
First Name:CHUN-XIAO
Middle Name:
Last Name:SUN
Suffix:
Gender:M
Credentials:DMD,MS,MSD,PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12258 MOUNTAIN HAZE RD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87122-1276
Mailing Address - Country:US
Mailing Address - Phone:909-792-0564
Mailing Address - Fax:
Practice Address - Street 1:8501 CANDELARIA RD NE STE D3
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-1032
Practice Address - Country:US
Practice Address - Phone:505-293-2334
Practice Address - Fax:505-293-2747
Is Sole Proprietor?:No
Enumeration Date:2010-03-15
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA591831223P0300X
TX246951223P0300X
NMDD42121223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
1023332350OtherNPI