Provider Demographics
NPI:1558199927
Name:SUN, QUAN (DTM)
Entity type:Individual
Prefix:
First Name:QUAN
Middle Name:
Last Name:SUN
Suffix:
Gender:F
Credentials:DTM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:443 AVONDALE CT
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-2424
Mailing Address - Country:US
Mailing Address - Phone:925-550-0085
Mailing Address - Fax:
Practice Address - Street 1:2260 GLADSTONE DR STE 4
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:CA
Practice Address - Zip Code:94565-5125
Practice Address - Country:US
Practice Address - Phone:925-550-0085
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-25
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC20060171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty