Provider Demographics
NPI:1861996175
Name:SUN, FANGDI
Entity type:Individual
Prefix:
First Name:FANGDI
Middle Name:
Last Name:SUN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 MONMOUTH ST APT 801
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-5637
Mailing Address - Country:US
Mailing Address - Phone:757-344-6917
Mailing Address - Fax:
Practice Address - Street 1:101 MONMOUTH ST APT 801
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-5637
Practice Address - Country:US
Practice Address - Phone:757-344-6917
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-21
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program