Provider Demographics
NPI:1730398496
Name:SUN, EUGENE YO-JEN (MD)
Entity type:Individual
Prefix:
First Name:EUGENE
Middle Name:YO-JEN
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 1:401 OLD ALBANY RD
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31792-4014
Mailing Address - Country:US
Mailing Address - Phone:229-228-8100
Mailing Address - Fax:229-228-8154
Practice Address - Street 1:401 OLD ALBANY RD
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792-4014
Practice Address - Country:US
Practice Address - Phone:229-228-8100
Practice Address - Fax:229-228-8154
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0621702084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA136681885AMedicaid
GA136681885AMedicaid