Provider Demographics
NPI:1861566689
Name:SABER, SHIEN-LIN SUN (PA-C)
Entity type:Individual
Prefix:
First Name:SHIEN-LIN
Middle Name:SUN
Last Name:SABER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SHIEN-LIN
Other - Middle Name:SUN
Other - Last Name:GARRETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:816 MANZANITA DR
Mailing Address - Street 2:
Mailing Address - City:LAGUNA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92651-1960
Mailing Address - Country:US
Mailing Address - Phone:949-338-5971
Mailing Address - Fax:
Practice Address - Street 1:1100 S COAST HWY STE 212
Practice Address - Street 2:
Practice Address - City:LAGUNA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92651-2975
Practice Address - Country:US
Practice Address - Phone:949-632-8087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA-15589363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP33786Medicare UPIN