Provider Demographics
NPI:1548603467
Name:SUN BIRD ACUPUNCTURE & TRADITIONAL HERBS CLINIC LLC
Entity Type:Organization
Organization Name:SUN BIRD ACUPUNCTURE & TRADITIONAL HERBS CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANGER
Authorized Official - Prefix:
Authorized Official - First Name:PENG
Authorized Official - Middle Name:
Authorized Official - Last Name:SUN
Authorized Official - Suffix:
Authorized Official - Credentials:DTCM
Authorized Official - Phone:623-552-0944
Mailing Address - Street 1:1845 W MARLETTE AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85015-2039
Mailing Address - Country:US
Mailing Address - Phone:623-552-0944
Mailing Address - Fax:
Practice Address - Street 1:1845 W MARLETTE AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-2039
Practice Address - Country:US
Practice Address - Phone:623-552-0944
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-10
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0844302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization