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General NPI Number Information
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NPI Number | 1295703882
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Entity Type | Individual
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Provider Name | JOHNNY WEI-TING SUN M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/09/2006
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Last Update Date | 08/27/2007
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Provider Practice Location Address
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Address Line | 2211 NE 139TH ST
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City | VANCOUVER
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State | WA
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Zip | 98686-2742
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Country | US
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Telephone | 360-487-5090
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Fax | 360-487-5009
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Provider Business Mailing Address
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Address Line | 8650 NW RYAN ST
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City | PORTLAND
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State | OR
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Zip | 97229-9181
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Country | US
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Telephone | 503-292-0809
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Fax | 503-292-0809
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | MD00044702
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License Number State | WA
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