Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0300X | Periodontist | 24695 | TX |
N | 1223P0300X | Periodontist | 59183 | CA |
Y | 1223P0300X | Periodontist | DD4212 | NM |
NPI | 1023332350 |
---|---|
Provider Name | Dr. Chun-Xiao Sun |
First Address | Albuquerque, NM 87122-1276 |
Second Address | Albuquerque, NM 87112-1032 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/03/2010 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1023332350 | NPI (01) |