Provider Demographics
NPI:1245303080
Name:SUN, HOWARD (MD)
Entity type:Individual
Prefix:
First Name:HOWARD
Middle Name:
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:PO BOX 1535
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98401-1535
Mailing Address - Country:US
Mailing Address - Phone:253-761-4200
Mailing Address - Fax:253-383-3553
Practice Address - Street 1:1304 FAWCETT AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-1911
Practice Address - Country:US
Practice Address - Phone:253-761-4200
Practice Address - Fax:253-383-3553
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000392262085R0202X
WA000392262085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7252SUOtherREGENCE BLUE SHIELD UNION AVENUE OPEN
WA142465OtherLABOR AND INDUSTRIES/WC TRA
WA300114620OtherRR MEDICARE TRA
WA3231SUOtherREGENCE BLUE SHIELD TRA
WA0249546OtherLABOR AND INDUSTRIES-MEDICAL IMAGING ON 1ST
WA142467OtherLABOR AND INDUSTRIES/WA UNION AVENUE OPEN
WAG8881870OtherPTAN-MIO1
WA8856152OtherMEDICARE PIN TRA KING COUNTY
WAG8927633OtherPTAN-UAOM
WA8244428Medicaid
WA8951862OtherLABOR AND INDUSTRIES CRIME VICTIMS-MEDICAL IMAGING ON 1ST
WA300114621OtherRR MEDICARE UNION AVENUE OPEN
WA142465OtherLABOR AND INDUSTRIES/WC TRA
WAG8927633OtherPTAN-UAOM
WA8244428Medicaid