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General NPI Number Information
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NPI Number | 1750535597
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Entity Type | Organization
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Legal Business Name | GREEN RUN FAMILY PRACTICE, INC
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Dates
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Enumeration Date | 11/06/2008
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Last Update Date | 11/06/2008
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Provider Practice Location Address
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Address Line | 3396 HOLLAND ROAD #105
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City | VIRGINIA BEACH
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State | VA
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Zip | 23452
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Country | US
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Telephone | 757-427-9194
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Fax |
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Provider Business Mailing Address
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Address Line | 3396 HOLLAND ROAD #105
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City | VIRGINIA BEACH
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State | VA
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Zip | 23452
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Country | US
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Telephone | 757-427-9194
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. TOMMY SUN
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Credential | MD
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Telephone | 757-427-9194
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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