Healthcare Provider Details

I. General information

NPI: 1467202002
Provider Name (Legal Business Name): CHRISTINA SUN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2024
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7500 BERGENLINE AVE FL 2
NORTH BERGEN NJ
07047-5401
US

IV. Provider business mailing address

7500 BERGENLINE AVE FL 2
NORTH BERGEN NJ
07047-5401
US

V. Phone/Fax

Practice location:
  • Phone: 201-945-1119
  • Fax: 201-945-1411
Mailing address:
  • Phone: 201-945-1119
  • Fax: 201-945-1411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number22DI03149800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: