Provider Demographics
NPI:1699111740
Name:SUN HEALING ARTS GROUP CLINIC
Entity type:Organization
Organization Name:SUN HEALING ARTS GROUP CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:
Authorized Official - Last Name:SUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-308-0660
Mailing Address - Street 1:288 S. SAN GABRIEL BLVD.
Mailing Address - Street 2:SUITE 206
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776-1668
Mailing Address - Country:US
Mailing Address - Phone:626-308-0660
Mailing Address - Fax:
Practice Address - Street 1:288 S. SAN GABRIEL BLVD.
Practice Address - Street 2:SUITE 206
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-1668
Practice Address - Country:US
Practice Address - Phone:626-308-0660
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-16
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA31180208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA31180OtherSTATE LICENSE