Provider Demographics
NPI:1336357433
Name:SUN, NICHOLAS H (DO)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:H
Last Name:SUN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3209 S 23RD ST STE 340
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-1602
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1703 S MERIDIAN STE 305
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98371-7590
Practice Address - Country:US
Practice Address - Phone:253-841-3933
Practice Address - Fax:253-848-7970
Is Sole Proprietor?:No
Enumeration Date:2007-05-20
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP60152129207RG0100X
MI5101015880207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1053813635OtherBCBSM
WAOP60152129OtherWA LICENSE
MIP21470004Medicare PIN
WA001045700Medicare PIN
I20189Medicare UPIN
WAOP60152129OtherWA LICENSE