Provider Demographics
NPI:1073233946
Name:SEAN SU MD LTD DBA SUNSHINE MEDICAL GROUP
Entity Type:Organization
Organization Name:SEAN SU MD LTD DBA SUNSHINE MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-338-9500
Mailing Address - Street 1:2451 PROFESSIONAL CT STE 110
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-0827
Mailing Address - Country:US
Mailing Address - Phone:702-338-9500
Mailing Address - Fax:
Practice Address - Street 1:2451 PROFESSIONAL CT STE 110
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0827
Practice Address - Country:US
Practice Address - Phone:702-240-4242
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-31
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty