Healthcare Provider Details

I. General information

NPI: 1841550092
Provider Name (Legal Business Name): RUIQING SUN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2012
Last Update Date: 08/02/2022
Certification Date: 07/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2660 GULF FWY S
LEAGUE CITY TX
77573-6820
US

IV. Provider business mailing address

PO BOX 650859 DEPT 710
DALLAS TX
75265-0859
US

V. Phone/Fax

Practice location:
  • Phone: 832-505-2100
  • Fax: 281-337-0704
Mailing address:
  • Phone: 409-772-8053
  • Fax: 409-747-1023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberBP10056527
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberS9609
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: