Provider Demographics
NPI:1770542342
Name:SUN, JIAN YI (MD)
Entity type:Individual
Prefix:
First Name:JIAN
Middle Name:YI
Last Name:SUN
Suffix:
Gender:F
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:PO BOX 5096
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98227-5096
Mailing Address - Country:US
Mailing Address - Phone:360-788-6841
Mailing Address - Fax:360-756-6847
Practice Address - Street 1:2901 SQUALICUM PKWY
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-1851
Practice Address - Country:US
Practice Address - Phone:360-756-6841
Practice Address - Fax:360-756-6847
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00043609207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8395188Medicaid
WA4455SUOtherREGENCE
WA8935188Medicaid
WAP00199693OtherRAILROAD MEDICARE
WA0188100OtherL&I AND CRIME VICTIMS
WA7133656OtherAETNA
WAG8803567Medicare PIN
WA8395188Medicaid