Provider Demographics
NPI:1083204630
Name:SUN GENOMICS, INC.
Entity Type:Organization
Organization Name:SUN GENOMICS, INC.
Other - Org Name:FLORE LABORATORIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LAB DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SAURABH
Authorized Official - Middle Name:
Authorized Official - Last Name:GOMBAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:317-850-2234
Mailing Address - Street 1:5151 SHOREHAM PL STE 105
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-5939
Mailing Address - Country:US
Mailing Address - Phone:661-888-4799
Mailing Address - Fax:
Practice Address - Street 1:5151 SHOREHAM PL STE 180
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92122-5961
Practice Address - Country:US
Practice Address - Phone:661-888-4799
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-19
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory MedicineGroup - Single Specialty
No207ZC0006XAllopathic & Osteopathic PhysiciansPathologyClinical PathologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05D2194956OtherCLIA