Provider Demographics
NPI:1265791891
Name:CAPTAIN, SUN (PA-C)
Entity type:Individual
Prefix:
First Name:SUN
Middle Name:
Last Name:CAPTAIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 VAN NESS AVE APT 52
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94102-3263
Mailing Address - Country:US
Mailing Address - Phone:415-794-8441
Mailing Address - Fax:510-981-8228
Practice Address - Street 1:3031 TELEGRAPH AVE STE 217
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-2053
Practice Address - Country:US
Practice Address - Phone:510-981-8222
Practice Address - Fax:510-981-8228
Is Sole Proprietor?:No
Enumeration Date:2012-05-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA17206363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA 17206OtherPA LICENSE
CAMC2316291OtherDEA NUMBER