MEDICARE: PETER SUN L.AC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	AC 9950	CA

General Provider Information

NPI Number	:	1477614667
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PETER SUN L.AC.

Provider Business Mailing Address
First Line	:	PO BOX 5535
Second Line	:
City	:	HACIENDA HEIGHTS
State	:	CA
Zip	:	91745-0535
Country	:	US
Telephone Number	:	626-617-3065
Fax Number	:	760-357-0688

Provider Business Practice Location Address
First Line	:	18438 COLIMA RD
Second Line	:	SUITE #10A
City	:	ROWLAND HEIGHTS
State	:	CA
Zip	:	91748-5819
Country	:	US
Telephone Number	:	626-617-3065
Fax Number	:	760-357-0688

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/12/2006
Last Update Date	:	07/08/2007

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