Basic Information
| Provider Information | |||||||||
| NPI: | 1245303080 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SUN | ||||||||
| FirstName: | HOWARD | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1535 | ||||||||
| Address2: | |||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984011535 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2537614200 | ||||||||
| FaxNumber: | 2533833553 | ||||||||
| Practice Location | |||||||||
| Address1: | 1304 FAWCETT AVE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984021911 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2537614200 | ||||||||
| FaxNumber: | 2533833553 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/17/2006 | ||||||||
| LastUpdateDate: | 09/16/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0204X | 00039226 | WA | N | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology | 2085R0202X | MD00039226 | WA | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 0249546 | 01 | WA | LABOR AND INDUSTRIES-MEDICAL IMAGING ON 1ST | OTHER | 142467 | 01 | WA | LABOR AND INDUSTRIES/WA UNION AVENUE OPEN | OTHER | 300114620 | 01 | WA | RR MEDICARE TRA | OTHER | G8927633 | 01 | WA | PTAN-UAOM | OTHER | 300114621 | 01 | WA | RR MEDICARE UNION AVENUE OPEN | OTHER | 7252SU | 01 | WA | REGENCE BLUE SHIELD UNION AVENUE OPEN | OTHER | 3231SU | 01 | WA | REGENCE BLUE SHIELD TRA | OTHER | 8244428 | 05 | WA | MEDICAID | 8856152 | 01 | WA | MEDICARE PIN TRA KING COUNTY | OTHER | G8881870 | 01 | WA | PTAN-MIO1 | OTHER | 142465 | 01 | WA | LABOR AND INDUSTRIES/WC TRA | OTHER | 8951862 | 01 | WA | LABOR AND INDUSTRIES CRIME VICTIMS-MEDICAL IMAGING ON 1ST | OTHER |