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General NPI Number Information
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NPI Number | 1992078711
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Entity Type | Organization
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Legal Business Name | SUN VALLEY FAMILY CARE PC
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Dates
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Enumeration Date | 02/10/2012
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Last Update Date | 04/17/2018
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Provider Practice Location Address
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Address Line | 1762 W BELL RD
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City | PHOENIX
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State | AZ
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Zip | 85023-3414
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Country | US
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Telephone | 602-504-6058
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Fax | 602-485-5156
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Provider Business Mailing Address
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Address Line | 16601 N 40TH ST SUITE 121
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City | PHOENIX
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State | AZ
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Zip | 85032-3345
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Country | US
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Telephone | 602-493-3677
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Fax | 602-485-5156
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Authorized Official
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Title or Position | PHYSICIAN
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Name | KUMAR DAULAT
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Credential | D.O.
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Telephone | 602-493-3677
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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 | 2635
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License Number State | AZ
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