Provider Demographics
NPI:1528572815
Name:SUN SURGERY CENTER HUNTINGTON LLC
Entity Type:Organization
Organization Name:SUN SURGERY CENTER HUNTINGTON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JEONGAE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-709-8552
Mailing Address - Street 1:7801 CENTER AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-9112
Mailing Address - Country:US
Mailing Address - Phone:714-709-8552
Mailing Address - Fax:657-227-7273
Practice Address - Street 1:7801 CENTER AVE STE 102
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-9112
Practice Address - Country:US
Practice Address - Phone:714-709-8552
Practice Address - Fax:657-227-7273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-22
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical