Healthcare Provider Details

I. General information

NPI: 1720201577
Provider Name (Legal Business Name): YI SUN M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 08/28/2023
Certification Date: 08/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5609 WATFORD TER
GLEN ALLEN VA
23059-3433
US

IV. Provider business mailing address

5609 WATFORD TERRACE
GLEN ALLEN VA
23059
US

V. Phone/Fax

Practice location:
  • Phone: 860-919-5632
  • Fax:
Mailing address:
  • Phone: 860-919-5632
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101251037
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number0101251037
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: