Krystal Sun, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

54167 Issued in CA

Practice address

101 Park PL Ste 200
San Ramon, CA 94583-1761

Phone

(925) 837-6000

Fax

(925) 837-6011

NPI assigned

Jan 29, 2017

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1485648000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560211200000",
    "number": "1174060115",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 PARK PL STE 200",
            "city": "SAN RAMON",
            "state": "CA",
            "postal_code": "945831761",
            "telephone_number": "925-837-6000",
            "fax_number": "925-837-6011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 PARK PL STE 200",
            "city": "SAN RAMON",
            "state": "CA",
            "postal_code": "945831761",
            "telephone_number": "925-837-6000",
            "fax_number": "925-837-6011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUN",
        "first_name": "KRYSTAL",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-01-29",
        "last_updated": "2019-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "54167",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "H28824",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sujatha Rajagopalan,M.D.,Inc
• Kimberly Sullivan
• Lily Nora Sullivan, M.S. CCC-SLP
• Summerville at Cobbco, Inc.
• Ivy Karen Sun, OD
• Nina Sun, DDS
• Snigdha Sunkara
• Alexandria Sunzeri
• Melanie Julia Heers Suozzi
• Marianne Superio

• Physician Assistant in San Ramon, CA
• Providers in San Ramon, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.