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General NPI Number Information
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NPI Number | 1710412028
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Entity Type | Individual
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Provider Name | ANDREW SUNDIN M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/24/2017
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Last Update Date | 12/31/2025
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Provider Practice Location Address
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Address Line | 18523 CORWIN RD STE A
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City | APPLE VALLEY
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State | CA
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Zip | 92307-2300
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Country | US
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Telephone | 909-712-2764
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Fax | 909-752-8719
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Provider Business Mailing Address
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Address Line | 18523 CORWIN RD STE A
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City | APPLE VALLEY
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State | CA
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Zip | 92307-2300
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Country | US
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Telephone | 909-712-2764
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Fax | 909-752-8719
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 163437
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License Number State | CA
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