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NPI Code Detail

MEDICARE: NINGYUAN SUN

MEDICARE: NINGYUAN 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
11223P0300XPeriodonticsDEN4997ME

General Provider Information

NPI Number : 1851959563
Entity Type Code : Individual
Provider Name (Legal Business Name) : NINGYUAN SUN
Provider Business Mailing Address
First Line : 716 STEVENS AVE OFC 308
Second Line :
City : PORTLAND
State : ME
Zip : 04103-2666
Country : US
Telephone Number : 617-690-9572
Fax Number :
Provider Business Practice Location Address
First Line : 1 COLLEGE ST
Second Line :
City : PORTLAND
State : ME
Zip : 04103-2617
Country : US
Telephone Number : 207-221-4747
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/29/2019
Last Update Date : 12/16/2025

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Directions to “ NINGYUAN SUN ” Practice Location

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