Provider Demographics
NPI:1437424330
Name:SUNDER MEDICAL CLINIC, INC.
Entity Type:Organization
Organization Name:SUNDER MEDICAL CLINIC, INC.
Other - Org Name:SUNDER HEART INSTITUTE & VASCULAR MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHUN
Authorized Official - Middle Name:K
Authorized Official - Last Name:SUNDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:661-726-3058
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:661-726-3060
Mailing Address - Fax:661-726-3723
Practice Address - Street 1:43860 10TH ST W
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-4848
Practice Address - Country:US
Practice Address - Phone:661-726-3060
Practice Address - Fax:661-726-3723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-12
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA26701207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A267010Medicaid
CA00A267010Medicaid