Healthcare Provider Details

I. General information

NPI: 1710532643
Provider Name (Legal Business Name): HIGH COUNTRY ANESTHESIOLOGY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2019
Last Update Date: 08/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7878 N 16TH ST STE 250
PHOENIX AZ
85020-4478
US

IV. Provider business mailing address

PO BOX 39179
PHOENIX AZ
85069-9179
US

V. Phone/Fax

Practice location:
  • Phone: 602-308-7830
  • Fax: 602-395-0718
Mailing address:
  • Phone: 602-395-0718
  • Fax: 602-277-8146

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: KAI SUN
Title or Position: OWNER
Credential: MD
Phone: 602-395-0718