Healthcare Provider Details

I. General information

NPI: 1255022208
Provider Name (Legal Business Name): CALVIN SUN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2023
Last Update Date: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12800 BOTHELL EVERETT HWY STE 250
EVERETT WA
98208-6644
US

IV. Provider business mailing address

12800 BOTHELL EVERETT HWY STE 250
EVERETT WA
98208-6644
US

V. Phone/Fax

Practice location:
  • Phone: 425-316-5440
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA70020973
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: