Provider Demographics
NPI:1194913343
Name:SUN, ROSE M (NP)
Entity type:Individual
Prefix:
First Name:ROSE
Middle Name:M
Last Name:SUN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MEI
Other - Middle Name:
Other - Last Name:SUN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:725 W DUARTE RD UNIT 1143
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91077-7011
Mailing Address - Country:US
Mailing Address - Phone:626-353-2594
Mailing Address - Fax:
Practice Address - Street 1:5522 GRACEWOOD AVE
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-8409
Practice Address - Country:US
Practice Address - Phone:626-353-2594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-11
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA543444163W00000X
CA20872363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA543444OtherSTATE BOARD OF RN
CA20872OtherSTATE BOARD OF RN