Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | A72737 | CA |
NPI | 1073590907 |
---|---|
Provider Name | Jimmy Jyh-Ming Sun |
First Address | Riverside, CA 92506-3912 |
Second Address | Corona, CA 92879-3128 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/12/2005 |
Last Update Date | 22/02/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H92463 | (02) | |
ZZZ31887Z | SITE PTAN (01) | CA |