Provider Demographics
NPI:1467629675
Name:SUNRISE MEDICAL CLINIC, INC.
Entity type:Organization
Organization Name:SUNRISE MEDICAL CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KYI
Authorized Official - Middle Name:
Authorized Official - Last Name:SAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-806-4040
Mailing Address - Street 1:9701 LAKEWOOD BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90240
Mailing Address - Country:US
Mailing Address - Phone:562-861-8999
Mailing Address - Fax:562-861-0999
Practice Address - Street 1:9701 LAKEWOOD BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90240
Practice Address - Country:US
Practice Address - Phone:562-861-8999
Practice Address - Fax:562-861-0999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-15
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty