Provider Demographics
NPI:1912227547
Name:SUN, SALLY S (MD)
Entity Type:Individual
Prefix:DR
First Name:SALLY
Middle Name:S
Last Name:SUN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SALLY
Other - Middle Name:SUT- YEE
Other - Last Name:SUN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:288 S SAN GABRIEL BLVD
Mailing Address - Street 2:STE 206
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776-1668
Mailing Address - Country:US
Mailing Address - Phone:559-431-8296
Mailing Address - Fax:559-431-8296
Practice Address - Street 1:288 S SAN GABRIEL BLVD
Practice Address - Street 2:STE 206
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-1668
Practice Address - Country:US
Practice Address - Phone:559-431-8296
Practice Address - Fax:559-431-8296
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-05
Last Update Date:2018-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA31180208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice