Basic Information
| Provider Information | |||||||||
| NPI: | 1881780229 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SUN | ||||||||
| FirstName: | JOANNIE | ||||||||
| MiddleName: | D | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 230 NEWPORT CENTER DR | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | NEWPORT BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926607509 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9497067766 | ||||||||
| FaxNumber: | 9497062211 | ||||||||
| Practice Location | |||||||||
| Address1: | 230 NEWPORT CENTER DR | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | NEWPORT BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926607509 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9497067766 | ||||||||
| FaxNumber: | 9497062211 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2006 | ||||||||
| LastUpdateDate: | 09/16/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | A72709 | CA | Y | Allopathic & Osteopathic Physicians | Dermatology |
ID Information
| ID | Type | State | Issuer | Description | 00A727090 | 01 | CA | BLUE SHIELD OF CALIFORNIA | OTHER |