Provider Demographics
NPI:1205901030
Name:SUN, DAZHONG (MD)
Entity type:Individual
Prefix:
First Name:DAZHONG
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 1:930 CARONDELET DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114-4855
Mailing Address - Country:US
Mailing Address - Phone:816-943-7600
Mailing Address - Fax:816-941-7456
Practice Address - Street 1:6115 PEACHTREE DUNWOODY RD STE 300
Practice Address - Street 2:
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30328-5695
Practice Address - Country:US
Practice Address - Phone:678-320-3600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005024758207RC0000X
GA91168207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP00853581OtherMEDICARE RAILROAD
MO1205901030Medicaid
MOP01100630OtherRAILROAD MEDICARE
MO1205901030Medicaid
MOMA2231007Medicare PIN
MOP00853581OtherMEDICARE RAILROAD