Healthcare Provider Details

I. General information

NPI: 1457627580
Provider Name (Legal Business Name): YEMING SUN M.D. INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2012
Last Update Date: 03/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 WATERWORKS WAY SUITE 125
IRVINE CA
92618-3168
US

IV. Provider business mailing address

113 WATERWORKS WAY SUITE 125
IRVINE CA
92618-3168
US

V. Phone/Fax

Practice location:
  • Phone: 949-552-6788
  • Fax: 949-552-7688
Mailing address:
  • Phone: 949-552-6788
  • Fax: 949-552-7688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberA69676
License Number StateCA

VIII. Authorized Official

Name: YEMING SUN
Title or Position: CEO
Credential: M.D.
Phone: 949-552-6788