Provider Demographics
NPI:1245626779
Name:SUN, CLEMENT SUNG-JAY (MD, PHD, MS)
Entity type:Individual
Prefix:DR
First Name:CLEMENT
Middle Name:SUNG-JAY
Last Name:SUN
Suffix:
Gender:M
Credentials:MD, PHD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5188 NW SAMMAMISH RD
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-9367
Mailing Address - Country:US
Mailing Address - Phone:425-591-8657
Mailing Address - Fax:
Practice Address - Street 1:5188 NW SAMMAMISH RD
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027
Practice Address - Country:US
Practice Address - Phone:425-591-8657
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-10
Last Update Date:2019-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD.MD.60924269207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine