Provider Demographics
NPI:1144356023
Name:SUN, JIAJI (LICAC)
Entity type:Individual
Prefix:MR
First Name:JIAJI
Middle Name:
Last Name:SUN
Suffix:
Gender:M
Credentials:LICAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6005 255TH ST FL 1
Mailing Address - Street 2:
Mailing Address - City:LITTLE NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11362-2438
Mailing Address - Country:US
Mailing Address - Phone:646-207-2021
Mailing Address - Fax:718-225-6007
Practice Address - Street 1:141 E 55TH ST APT 6G
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-4032
Practice Address - Country:US
Practice Address - Phone:646-207-2021
Practice Address - Fax:718-225-6007
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000581171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist