Provider Demographics
NPI:1376557132
Name:SUNDER, SHUN K (MD)
Entity Type:Individual
Prefix:DR
First Name:SHUN
Middle Name:K
Last Name:SUNDER
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 1:43860 10TH ST W
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-4848
Mailing Address - Country:US
Mailing Address - Phone:661-726-3058
Mailing Address - Fax:661-726-3723
Practice Address - Street 1:43860 N. 10TH ST. WEST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534
Practice Address - Country:US
Practice Address - Phone:661-726-3060
Practice Address - Fax:661-726-3723
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2013-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA26701174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A267010Medicare ID - Type Unspecified
CAA87071Medicare UPIN