Provider Demographics
NPI:1811977069
Name:SUN, YEMING (MD)
Entity type:Individual
Prefix:
First Name:YEMING
Middle Name:
Last Name:SUN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 WATERWORKS WAY
Mailing Address - Street 2:#125
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-3168
Mailing Address - Country:US
Mailing Address - Phone:949-552-6788
Mailing Address - Fax:
Practice Address - Street 1:113 WATERWORKS WAY
Practice Address - Street 2:#125
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3168
Practice Address - Country:US
Practice Address - Phone:949-552-6788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-21
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA69676207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H27784Medicare UPIN
A69676Medicare ID - Type Unspecified