Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 44552 | AZ |
NPI | 1013037985 |
---|---|
Provider Name | Kai Sun |
First Address | Phoenix, AZ 85004-4633 |
Second Address | Phoenix, AZ 85004-4633 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2007 |
Last Update Date | 24/09/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
630301 | (05) | AZ |