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General NPI Number Information
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NPI Number | 1689208399
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Entity Type | Organization
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Legal Business Name | SUN PM&R LLC
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Dates
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Enumeration Date | 03/03/2020
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Last Update Date | 03/03/2020
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Provider Practice Location Address
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Address Line | 4810 N KINGS HWY
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City | MYRTLE BEACH
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State | SC
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Zip | 29577-2558
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Country | US
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Telephone | 732-241-5585
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Fax | 732-662-5226
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Provider Business Mailing Address
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Address Line | 1525 GENOA CT
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City | MYRTLE BEACH
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State | SC
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Zip | 29579-5249
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Country | US
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Telephone | 908-902-3474
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Fax | 732-662-5226
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Authorized Official
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Title or Position | SOLE PROPRIETER
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Name | JIDONG SUN
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Credential | MD
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Telephone | 732-241-5585
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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