Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | MA70679 | NJ |
NPI | 1033158282 |
---|---|
Provider Name | Jidong Sun |
First Address | Hamilton, NJ 08619-3829 |
Second Address | Hamilton, NJ 08619-3829 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2006 |
Last Update Date | 04/12/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0073539 | (05) | NJ |
H25170 | (02) | NJ |