Provider Demographics
NPI:1346689833
Name:SUN LIVING HEALTH AND WELLNESS
Entity Type:Organization
Organization Name:SUN LIVING HEALTH AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALS
Authorized Official - Prefix:
Authorized Official - First Name:KIRSTEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:SORENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-431-1152
Mailing Address - Street 1:22150 HAWTHORNE BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-7007
Mailing Address - Country:US
Mailing Address - Phone:310-370-0008
Mailing Address - Fax:310-370-0015
Practice Address - Street 1:22150 HAWTHORNE BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-7007
Practice Address - Country:US
Practice Address - Phone:310-370-0008
Practice Address - Fax:310-370-0015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-18
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA112622208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty