Provider Demographics
NPI:1366946121
Name:SUN, BO (MD)
Entity type:Individual
Prefix:
First Name:BO
Middle Name:
Last Name:SUN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 PASTEUR DRIVE
Mailing Address - Street 2:LANE 154
Mailing Address - City:STANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:94305-5133
Mailing Address - Country:US
Mailing Address - Phone:650-723-6661
Mailing Address - Fax:650-498-6205
Practice Address - Street 1:300 PASTEUR DRIVE
Practice Address - Street 2:LANE 154
Practice Address - City:STANFORD
Practice Address - State:CA
Practice Address - Zip Code:94305-5133
Practice Address - Country:US
Practice Address - Phone:650-723-6661
Practice Address - Fax:650-498-6205
Is Sole Proprietor?:No
Enumeration Date:2018-03-19
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA164146207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine