Healthcare Provider Details

I. General information

NPI: 1174898019
Provider Name (Legal Business Name): DEREK SUN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2012
Last Update Date: 09/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 DIVISADERO ST ROOM C250
SAN FRANCISCO CA
94115-3010
US

IV. Provider business mailing address

1600 DIVISADERO ST ROOM C250
SAN FRANCISCO CA
94115-3010
US

V. Phone/Fax

Practice location:
  • Phone: 415-885-7464
  • Fax: 415-885-7876
Mailing address:
  • Phone: 415-885-7464
  • Fax: 415-885-7876

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License NumberA125532
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: