Healthcare Provider Details

I. General information

NPI: 1003234063
Provider Name (Legal Business Name): SHIH-FAN SUN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2014
Last Update Date: 09/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 DEEP VALLEY DR STE 100
ROLLING HILLS ESTATES CA
90274-7606
US

IV. Provider business mailing address

5767 W CENTURY BLVD SUITE 400
LOS ANGELES CA
90045-5631
US

V. Phone/Fax

Practice location:
  • Phone: 310-303-3953
  • Fax: 310-303-7903
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA140568
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA140568
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: