Provider Demographics
NPI:1457592024
Name:SUN, MICHAEL YL (DC, LAC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:YL
Last Name:SUN
Suffix:
Gender:M
Credentials:DC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12721 DAIRY ST
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92880-3453
Mailing Address - Country:US
Mailing Address - Phone:951-272-2897
Mailing Address - Fax:
Practice Address - Street 1:116 W LIME AVE
Practice Address - Street 2:
Practice Address - City:MONROVIA
Practice Address - State:CA
Practice Address - Zip Code:91016-2841
Practice Address - Country:US
Practice Address - Phone:626-599-8323
Practice Address - Fax:626-768-7459
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-11
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC31027111N00000X
CAAC13426171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist