Provider Demographics
NPI:1730339854
Name:SUN, JIANLAN (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:JIANLAN
Middle Name:
Last Name:SUN
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:JIAN-LAN
Other - Middle Name:
Other - Last Name:SUN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD, PHD
Mailing Address - Street 1:P.O. BOX 1188
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:OH
Mailing Address - Zip Code:43402-1188
Mailing Address - Country:US
Mailing Address - Phone:419-861-7052
Mailing Address - Fax:
Practice Address - Street 1:1111 HAYES AVE
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-3323
Practice Address - Country:US
Practice Address - Phone:419-557-7400
Practice Address - Fax:716-859-1958
Is Sole Proprietor?:No
Enumeration Date:2008-09-25
Last Update Date:2017-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH098895207ZP0102X
NY253506207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology