Healthcare Provider Details

I. General information

NPI: 1467771287
Provider Name (Legal Business Name): BRYAN A SUNDIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2010
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22610 SE 240TH ST STE 100
MAPLE VALLEY WA
98038-5086
US

IV. Provider business mailing address

PO BOX 34876
SEATTLE WA
98124-1876
US

V. Phone/Fax

Practice location:
  • Phone: 425-690-3460
  • Fax: 425-690-9460
Mailing address:
  • Phone: 425-656-5412
  • Fax: 425-656-4096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD602983521
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: