Provider Demographics
NPI:1396908141
Name:SUNKARA, NIRMAL T (MD)
Entity type:Individual
Prefix:
First Name:NIRMAL
Middle Name:T
Last Name:SUNKARA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5979 S FASHION BLVD
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-7364
Mailing Address - Country:US
Mailing Address - Phone:801-263-2370
Mailing Address - Fax:
Practice Address - Street 1:333 CITY BLVD W
Practice Address - Street 2:400
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868
Practice Address - Country:US
Practice Address - Phone:714-456-3868
Practice Address - Fax:888-433-9843
Is Sole Proprietor?:No
Enumeration Date:2008-07-02
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV13995207R00000X
CAA119826207R00000X
UT9386778-1205207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1184601239Medicaid
NV1184601239Medicaid