Provider Demographics
NPI:1326039405
Name:SUNKU, VINAY A (MD)
Entity Type:Individual
Prefix:
First Name:VINAY
Middle Name:A
Last Name:SUNKU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43932 15TH ST W STE 101
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-5234
Mailing Address - Country:US
Mailing Address - Phone:661-945-2299
Mailing Address - Fax:
Practice Address - Street 1:43932 15TH ST W STE 101
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-5234
Practice Address - Country:US
Practice Address - Phone:661-945-2299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-28
Last Update Date:2010-11-18
Deactivation Date:2006-03-25
Deactivation Code:
Reactivation Date:2006-04-06
Provider Licenses
StateLicense IDTaxonomies
CAA54362207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A543621Medicaid
CAA54632Medicare ID - Type Unspecified
CAG26201Medicare UPIN