Healthcare Provider Details

I. General information

NPI: 1083204630
Provider Name (Legal Business Name): SUN GENOMICS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2021
Last Update Date: 03/22/2023
Certification Date: 03/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5151 SHOREHAM PL STE 180
SAN DIEGO CA
92122-5961
US

IV. Provider business mailing address

5151 SHOREHAM PL STE 105
SAN DIEGO CA
92122-5939
US

V. Phone/Fax

Practice location:
  • Phone: 661-888-4799
  • Fax:
Mailing address:
  • Phone: 661-888-4799
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZC0006X
TaxonomyClinical Pathology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SAURABH GOMBAR
Title or Position: LAB DIRECTOR
Credential: M.D., PH.D.
Phone: 317-850-2234