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General NPI Number Information
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NPI Number | 1790791184
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Entity Type | Organization
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Legal Business Name | SUN ORTHOPAEDIC SURGERY PC
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Dates
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Enumeration Date | 07/31/2006
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Last Update Date | 06/25/2019
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Provider Practice Location Address
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Address Line | 13625 37TH AVE STE 304
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City | FLUSHING
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State | NY
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Zip | 11354-4169
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Country | US
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Telephone | 718-461-2666
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Fax |
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Provider Business Mailing Address
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Address Line | 9 GRADUATE CT
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City | EAST SETAUKET
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State | NY
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Zip | 11733-1079
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Country | US
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Telephone | 631-828-0070
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Fax |
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Authorized Official
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Title or Position | CHAIRMAN
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Name | YAN SUN
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Credential | MD
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Telephone | 718-461-2666
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 220000
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License Number State | NY
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