Healthcare Provider Details

I. General information

NPI: 1609979962
Provider Name (Legal Business Name): CHILDREN'S NEUROSURGICAL ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

747 52ND STREET SUITE 5203
OAKLAND CA
94609
US

IV. Provider business mailing address

747 52ND STREET SUITE 5203
OAKLAND CA
94609
US

V. Phone/Fax

Practice location:
  • Phone: 510-428-3319
  • Fax:
Mailing address:
  • Phone: 510-428-3319
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberG76016
License Number StateCA

VIII. Authorized Official

Name: DR. PETER P. SUN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 510-428-3319