Healthcare Provider Details

I. General information

NPI: 1750802666
Provider Name (Legal Business Name): HAOZHE SUN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2017
Last Update Date: 11/08/2024
Certification Date: 11/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1818 COLE ST FL 1
ENUMCLAW WA
98022-3504
US

IV. Provider business mailing address

1818 COLE ST FL 1
ENUMCLAW WA
98022-3504
US

V. Phone/Fax

Practice location:
  • Phone: 360-802-5032
  • Fax: 360-802-5039
Mailing address:
  • Phone: 360-802-5032
  • Fax: 360-802-5039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD61476452
License Number StateWA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier2289939
Identifier TypeMEDICAID
Identifier StateWA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: