Provider Demographics
NPI:1992078711
Name:SUN VALLEY FAMILY CARE PC
Entity type:Organization
Organization Name:SUN VALLEY FAMILY CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:KUMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:DAULAT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:602-493-3677
Mailing Address - Street 1:16601 N 40TH ST
Mailing Address - Street 2:SUITE 121
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-3345
Mailing Address - Country:US
Mailing Address - Phone:602-493-3677
Mailing Address - Fax:602-485-5156
Practice Address - Street 1:1762 W BELL RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85023-3414
Practice Address - Country:US
Practice Address - Phone:602-504-6058
Practice Address - Fax:602-485-5156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-10
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2635207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ182874Medicaid
AZ182874Medicaid