=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619140720
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HUAN HUAN SUN M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/09/2008
-----------------------------------------------------
Last Update Date | 10/15/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 45 READE PLACE DYSON CENTER, 3RD FLOOR
-----------------------------------------------------
City | POUGHKEEPSIE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12601
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-483-6920
-----------------------------------------------------
Fax | 845-483-6922
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1351 ROUTE 55 STE 200
-----------------------------------------------------
City | LAGRANGEVILLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12540-5128
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2086X0206X
-----------------------------------------------------
Taxonomy Name | Surgical Oncology Physician
-----------------------------------------------------
License Number | 278735
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | 278735
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 208G00000X
-----------------------------------------------------
Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
-----------------------------------------------------
License Number | 278735
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------