Healthcare Provider Details

I. General information

NPI: 1386258663
Provider Name (Legal Business Name): LI SUN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2020
Last Update Date: 12/01/2020
Certification Date: 12/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29800 BAINBRIDGE RD
SOLON OH
44139-2202
US

IV. Provider business mailing address

2049 EAST 100TH STREET A50
CLEVELAND OH
44195-0002
US

V. Phone/Fax

Practice location:
  • Phone: 216-444-2200
  • Fax:
Mailing address:
  • Phone: 216-444-2200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number50.006606RX
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.006606RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: