Provider Demographics
NPI:1720734569
Name:SUN, JI (PHARMD/PHD)
Entity Type:Individual
Prefix:
First Name:JI
Middle Name:
Last Name:SUN
Suffix:
Gender:M
Credentials:PHARMD/PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9452 MEDICAL CENTER DR RM 1E314
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92093-0897
Mailing Address - Country:US
Mailing Address - Phone:858-822-2805
Mailing Address - Fax:
Practice Address - Street 1:9452 MEDICAL CENTER DR RM 1E314
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92093-0897
Practice Address - Country:US
Practice Address - Phone:858-822-2805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-01
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH605821835N1003X, 1835X0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1835X0200XPharmacy Service ProvidersPharmacistOncologyGroup - Multi-Specialty
No1835N1003XPharmacy Service ProvidersPharmacistNutrition SupportGroup - Multi-Specialty