Basic Information
Provider Information | |||||||||
NPI: | 1316913098 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SUN | ||||||||
FirstName: | YUN | ||||||||
MiddleName: |   | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 645 N MAIN ST | ||||||||
Address2: |   | ||||||||
City: | HIGH POINT | ||||||||
State: | NC | ||||||||
PostalCode: | 272605017 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3368830029 | ||||||||
FaxNumber: | 3368830867 | ||||||||
Practice Location | |||||||||
Address1: | 3402 BATTLEGROUND AVE | ||||||||
Address2: |   | ||||||||
City: | GREENSBORO | ||||||||
State: | NC | ||||||||
PostalCode: | 274102404 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3368830029 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 02/23/2006 | ||||||||
LastUpdateDate: | 12/08/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 12/08/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 9500244 | NC | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 208VP0000X | 9500244 | NC | Y |   | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine |
ID Information
ID | Type | State | Issuer | Description | 5829182001 | 01 | NC | CIGNA HEALTHCARE NUMBER | OTHER | 5935014 | 01 | NC | AETNA - NON HMO NUMBER | OTHER | 81004 | 01 | NC | BCBS NUMBER | OTHER | 41363 | 01 | NC | WELLPATH/COVENTRY NUMBER | OTHER | 110207881 | 01 | NC | RAILROAD MEDICARE NUMBER | OTHER | 291934 | 01 | NC | MAMSI NUMBER | OTHER | 8981004 | 05 | NC |   | MEDICAID | 0408169 | 01 | NC | UNITED HEALTHCARE NUMBER | OTHER | 2723691 | 01 | NC | AETNA - HMO NUMBER | OTHER | 9886 | 01 | NC | PARTNERS MEDICARE CHOICE | OTHER | 92347 | 01 | NC | MEDCOST NUMBER | OTHER |