Provider Demographics
NPI:1801806732
Name:SUN, WYNNSHANG CHEN (MD)
Entity type:Individual
Prefix:
First Name:WYNNSHANG
Middle Name:CHEN
Last Name:SUN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9850 GENESEE AVE
Mailing Address - Street 2:STE 870
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037
Mailing Address - Country:US
Mailing Address - Phone:858-452-7040
Mailing Address - Fax:858-452-7137
Practice Address - Street 1:9850 GENESEE AVE
Practice Address - Street 2:STE 870
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037
Practice Address - Country:US
Practice Address - Phone:858-452-7040
Practice Address - Fax:858-452-7137
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA63389207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAQIIOMedicare PIN