Healthcare Provider Details

I. General information

NPI: 1144726829
Provider Name (Legal Business Name): SOPHIE SUN MD, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2018
Last Update Date: 08/18/2022
Certification Date: 08/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11234 ANDERSON ST
LOMA LINDA CA
92354
US

IV. Provider business mailing address

11234 ANDERSON ST # MC-1516
LOMA LINDA CA
92354-2804
US

V. Phone/Fax

Practice location:
  • Phone: 877-558-6248
  • Fax:
Mailing address:
  • Phone: 909-558-4884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA163986
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA163986
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: