MEDICARE: JIDONG SUN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician	MA70679	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033158282
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JIDONG SUN

Provider Business Mailing Address
First Line	:	1542 KUSER RD STE B3
Second Line	:
City	:	HAMILTON
State	:	NJ
Zip	:	08619-3829
Country	:	US
Telephone Number	:	732-888-3300
Fax Number	:	732-888-3116

Provider Business Practice Location Address
First Line	:	1542 KUSER RD STE B3
Second Line	:
City	:	HAMILTON
State	:	NJ
Zip	:	08619-3829
Country	:	US
Telephone Number	:	732-888-3300
Fax Number	:	732-888-3116

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/05/2006
Last Update Date	:	12/04/2018

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Directions to “ JIDONG SUN ” Practice Location

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