Provider Demographics
NPI:1871970574
Name:SUN MEDICAL CENTER, LLC
Entity type:Organization
Organization Name:SUN MEDICAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OF SUN MEDICAL CENTER, LLC.
Authorized Official - Prefix:
Authorized Official - First Name:SUN HEE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-752-4623
Mailing Address - Street 1:7700 LITTLE RIVER TPKE
Mailing Address - Street 2:SUITE 100B
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-2406
Mailing Address - Country:US
Mailing Address - Phone:703-752-4623
Mailing Address - Fax:703-762-9978
Practice Address - Street 1:7700 LITTLE RIVER TPKE
Practice Address - Street 2:SUITE 100B
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-2406
Practice Address - Country:US
Practice Address - Phone:703-752-4623
Practice Address - Fax:703-762-9978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-01
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0121000672171100000X
VA0101038823207Q00000X, 207X00000X
VA2305209975225100000X
225100000X
VA0019004519225700000X
VA247ZC0005X
VA0101230358261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
No247ZC0005XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyClinical Laboratory Director, Non-physicianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1871970574Medicare PIN