Healthcare Provider Details

I. General information

NPI: 1801258843
Provider Name (Legal Business Name): KARL SUN, M.D. INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2016
Last Update Date: 03/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5555 RESERVOIR DRIVE SUITE 112
SAN DIEGO CA
92120
US

IV. Provider business mailing address

5555 RESERVOIR DRIVE SUITE 112
SAN DIEGO CA
92120
US

V. Phone/Fax

Practice location:
  • Phone: 619-287-7060
  • Fax: 619-287-7078
Mailing address:
  • Phone: 619-287-7060
  • Fax: 619-287-7078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA68612
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License NumberA68612
License Number StateCA

VIII. Authorized Official

Name: MR. KARL SUN
Title or Position: PHYSICIAN/OWNER
Credential: M.D.
Phone: 619-287-7060