Healthcare Provider Details

I. General information

NPI: 1326770504
Provider Name (Legal Business Name): LUCY CHEN SUN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2022
Last Update Date: 03/05/2024
Certification Date: 03/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1703 TERMINO AVE STE 108
LONG BEACH CA
90804-2126
US

IV. Provider business mailing address

30 REVERE BEACH PKWY APT 402
MEDFORD MA
02155-5162
US

V. Phone/Fax

Practice location:
  • Phone: 562-498-2481
  • Fax: 562-494-6651
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95021445
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2347775
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95282803
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: