Healthcare Provider Details

I. General information

NPI: 1972829257
Provider Name (Legal Business Name): KF SUNRAY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2010
Last Update Date: 09/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3210 WEST PICO BOULEVARD
LOS ANGELES CA
90019
US

IV. Provider business mailing address

3210 WEST PICO BOULEVARD
LOS ANGELES CA
90019
US

V. Phone/Fax

Practice location:
  • Phone: 323-734-2171
  • Fax: 323-734-1825
Mailing address:
  • Phone: 323-734-2171
  • Fax: 323-734-1825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. DOUGLAS EASTON
Title or Position: PRESIDENT
Credential:
Phone: 714-533-7818