1790855799 NPI number — DR. DANNY DA-NIE SUN M.D.

Table of content: DR. DANNY DA-NIE SUN M.D. (NPI 1790855799)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790855799 NPI number — DR. DANNY DA-NIE SUN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SUN
Provider First Name:
DANNY
Provider Middle Name:
DA-NIE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1790855799
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
145 105TH AVE SE
Provider Second Line Business Mailing Address:
11
Provider Business Mailing Address City Name:
BELLEVUE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98004-6254
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-443-7211
Provider Business Mailing Address Fax Number:
425-257-9817

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3229 HOYT AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EVERETT
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98201-6404
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-257-9880
Provider Business Practice Location Address Fax Number:
425-257-9817
Provider Enumeration Date:
11/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208200000X , with the licence number:  MD00035697 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 8019739 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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