Provider Demographics
NPI:1972590354
Name:SUN, PETER P (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:P
Last Name:SUN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:744 52ND ST
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-1810
Mailing Address - Country:US
Mailing Address - Phone:510-428-3319
Mailing Address - Fax:510-597-7034
Practice Address - Street 1:744 52ND ST
Practice Address - Street 2:5TH FLOOR
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-1810
Practice Address - Country:US
Practice Address - Phone:510-428-3319
Practice Address - Fax:510-597-7034
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-30
Last Update Date:2013-03-14
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Provider Licenses
StateLicense IDTaxonomies
CAG76016207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G760160Medicaid