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Individual

SUSIE XINYING SUN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
1515 HOLCOMBE BLVD, HOUSTON, TX 77030-4009
(713) 792-6161
Mailing address
P O BOX 4439, HOUSTON, TX 77210-4439
(713) 792-2991

Taxonomy

Speciality
Code
Description
License number
State
208600000X
Surgery Physician
MT200108
PA
208600000X
Surgery Physician
Primary
R6917
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
397830601
TX
01
397830602
CSHCN MEDICAID
TX
01
8KI913
BLUE CROSS BLUE SHIELD
TX
Enumeration date
06/08/2011
Last updated
07/18/2019
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