Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | A128359 | CA |
N | 208G00000X | Cardiothoracic Vascular Surgeon | MD60226713 | WA |
NPI | 1043518251 |
---|---|
Provider Name | Dr. Jack Sun |
First Address | Los Angeles, CA 90031-0309 |
Second Address | Los Angeles, CA 90033-5310 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/03/2011 |
Last Update Date | 07/07/2014 |