Provider Demographics
NPI:1487696241
Name:SUN, XIWU JOHN (MD)
Entity type:Individual
Prefix:DR
First Name:XIWU JOHN
Middle Name:
Last Name:SUN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:7250 JANUS PARK DR
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13088-3847
Mailing Address - Country:US
Mailing Address - Phone:315-475-8402
Mailing Address - Fax:315-475-0824
Practice Address - Street 1:7250 JANUS PARK DR
Practice Address - Street 2:
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13088-3847
Practice Address - Country:US
Practice Address - Phone:315-475-8402
Practice Address - Fax:315-475-0824
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY228896207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02660382Medicaid
NYRB1501Medicare PIN
NYI56071Medicare UPIN
NY02660382Medicaid
NYRB0738Medicare PIN