Provider Demographics
NPI:1881780229
Name:SUN, JOANNIE D (MD)
Entity type:Individual
Prefix:DR
First Name:JOANNIE
Middle Name:D
Last Name:SUN
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Gender:F
Credentials:MD
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Mailing Address - Street 1:230 NEWPORT CENTER DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7509
Mailing Address - Country:US
Mailing Address - Phone:949-706-7766
Mailing Address - Fax:949-706-2211
Practice Address - Street 1:230 NEWPORT CENTER DR
Practice Address - Street 2:SUITE 200
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7509
Practice Address - Country:US
Practice Address - Phone:949-706-7766
Practice Address - Fax:949-706-2211
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2011-09-16
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Provider Licenses
StateLicense IDTaxonomies
CAA72709207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A727090OtherBLUE SHIELD OF CALIFORNIA
I07384Medicare UPIN
CAWA72709BMedicare ID - Type Unspecified
CAWA72709AMedicare ID - Type Unspecified