Provider Demographics
NPI:1447477898
Name:A SUN MEDICAL CLINIC CO
Entity type:Organization
Organization Name:A SUN MEDICAL CLINIC CO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:S
Authorized Official - Last Name:SUN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-308-0660
Mailing Address - Street 1:288 S SAN GABRIEL BLVD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776-1668
Mailing Address - Country:US
Mailing Address - Phone:626-308-0660
Mailing Address - Fax:
Practice Address - Street 1:288 S SAN GABRIEL BLVD
Practice Address - Street 2:SUITE 206
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-1668
Practice Address - Country:US
Practice Address - Phone:626-308-0660
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG13537207Q00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG13537OtherSTATE LICENSE
CA00G135370Medicaid
CAG13537BMedicare ID - Type Unspecified