Healthcare Provider Details

I. General information

NPI: 1598239618
Provider Name (Legal Business Name): VINCENT SUN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2019
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14724 VENTURA BLVD
SHERMAN OAKS CA
91403-3501
US

IV. Provider business mailing address

28245 AVENUE CROCKER
VALENCIA CA
91355-0940
US

V. Phone/Fax

Practice location:
  • Phone: 747-298-3480
  • Fax:
Mailing address:
  • Phone: 661-254-7086
  • Fax: 661-254-7108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number11833971
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: