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General NPI Number Information
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NPI Number | 1023332350
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Entity Type | Individual
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Provider Name | CHUN-XIAO SUN DMD,MS,MSD,PHD
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Gender | Male
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Dates
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Enumeration Date | 03/15/2010
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 8501 CANDELARIA RD NE STE D3
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City | ALBUQUERQUE
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State | NM
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Zip | 87112-1032
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Country | US
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Telephone | 505-293-2334
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Fax | 505-293-2747
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Provider Business Mailing Address
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Address Line | 12258 MOUNTAIN HAZE RD NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87122-1276
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Country | US
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Telephone | 909-792-0564
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 59183
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 24695
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | DD4212
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License Number State | NM
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