Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207T00000X | Neurosurgeon | 63629-20 | WI |
Y | 207T00000X | Neurosurgeon | Q6578 | TX |
N | 207X00000X | Orthopaedic Surgeon | 63629-20 | WI |
NPI | 1093987067 |
---|---|
Provider Name | Mr. Derrick Yuan Sun |
First Address | San Antonio, TX 78229-3901 |
Second Address | San Antonio, TX 78229-3901 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2008 |
Last Update Date | 12/09/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
358901201 | (05) | TX |
358901202 | CSHCN (01) | TX |