Provider Demographics
NPI:1699145474
Name:SUN, CHI (LLM, MAOM)
Entity type:Individual
Prefix:
First Name:CHI
Middle Name:
Last Name:SUN
Suffix:
Gender:F
Credentials:LLM, MAOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 HARRISON ST # 1
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-6951
Mailing Address - Country:US
Mailing Address - Phone:617-838-8051
Mailing Address - Fax:
Practice Address - Street 1:77 TURNPIKE RD
Practice Address - Street 2:
Practice Address - City:IPSWICH
Practice Address - State:MA
Practice Address - Zip Code:01938-1003
Practice Address - Country:US
Practice Address - Phone:978-412-8272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-05
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist