Provider Demographics
NPI:1902917164
Name:SUN, JIANPING (MD)
Entity Type:Individual
Prefix:DR
First Name:JIANPING
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 1:4500 NE SUNSET BLVD
Mailing Address - Street 2:SUITE D
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98059-4054
Mailing Address - Country:US
Mailing Address - Phone:425-271-1255
Mailing Address - Fax:425-271-1256
Practice Address - Street 1:4500 NE SUNSET BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98059-4054
Practice Address - Country:US
Practice Address - Phone:425-271-1255
Practice Address - Fax:425-271-1256
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN35640207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3869134Medicaid
TN3869134Medicare ID - Type Unspecified
TN3869134Medicaid
6238000001Medicare NSC