Provider Demographics
NPI:1174768790
Name:SUN, JOEL YAO (MS)
Entity type:Individual
Prefix:
First Name:JOEL
Middle Name:YAO
Last Name:SUN
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:JIYAO
Other - Middle Name:
Other - Last Name:SUN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2624 FOOTHILL BLVD
Mailing Address - Street 2:208
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94601-1769
Mailing Address - Country:US
Mailing Address - Phone:510-436-6017
Mailing Address - Fax:
Practice Address - Street 1:2624 FOOTHILL BLVD
Practice Address - Street 2:208
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94601-1769
Practice Address - Country:US
Practice Address - Phone:510-436-6017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-11
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMTA40732246QM0706X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QM0706XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMedical Technologist