Provider Demographics
NPI:1093291452
Name:SUN, SOPHIA WONG (OD)
Entity type:Individual
Prefix:DR
First Name:SOPHIA
Middle Name:WONG
Last Name:SUN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MS
Other - First Name:SOPHIA
Other - Middle Name:
Other - Last Name:WONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:2014 PALMETTO AVE STE B
Mailing Address - Street 2:
Mailing Address - City:PACIFICA
Mailing Address - State:CA
Mailing Address - Zip Code:94044-2796
Mailing Address - Country:US
Mailing Address - Phone:650-359-2231
Mailing Address - Fax:650-359-2305
Practice Address - Street 1:2014 PALMETTO AVE STE B
Practice Address - Street 2:
Practice Address - City:PACIFICA
Practice Address - State:CA
Practice Address - Zip Code:94044-2796
Practice Address - Country:US
Practice Address - Phone:650-359-2231
Practice Address - Fax:650-359-2305
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-18
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33991TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist