Healthcare Provider Details

I. General information

NPI: 1447477898
Provider Name (Legal Business Name): A SUN MEDICAL CLINIC CO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 08/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

288 S SAN GABRIEL BLVD SUITE 206
SAN GABRIEL CA
91776-1668
US

IV. Provider business mailing address

288 S SAN GABRIEL BLVD SUITE 206
SAN GABRIEL CA
91776-1668
US

V. Phone/Fax

Practice location:
  • Phone: 626-308-0660
  • Fax:
Mailing address:
  • Phone: 626-308-0660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG13537
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG13537
License Number StateCA

VIII. Authorized Official

Name: DR. ANDREW S. SUN
Title or Position: PROVIDER/OWNER
Credential: M.D.
Phone: 626-308-0660