Provider Demographics
NPI:1558195107
Name:SUN VIDA MEDICAL CLINIC INC
Entity type:Organization
Organization Name:SUN VIDA MEDICAL CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VICRUMDEEP
Authorized Official - Middle Name:SINGH
Authorized Official - Last Name:TUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-208-1077
Mailing Address - Street 1:8133 SAN FERNANDO RD STE B1
Mailing Address - Street 2:
Mailing Address - City:SUN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91352-4065
Mailing Address - Country:US
Mailing Address - Phone:818-208-1077
Mailing Address - Fax:
Practice Address - Street 1:8133 SAN FERNANDO RD STE B1
Practice Address - Street 2:
Practice Address - City:SUN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91352-4065
Practice Address - Country:US
Practice Address - Phone:818-208-1077
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-27
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty