Provider Demographics
NPI:1578852109
Name:PHILIP, SUNNY KOIPURATHU JR (MD)
Entity Type:Individual
Prefix:DR
First Name:SUNNY
Middle Name:KOIPURATHU
Last Name:PHILIP
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:2626 N CALIFORNIA ST STE B
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95204-5500
Mailing Address - Country:US
Mailing Address - Phone:209-466-2626
Mailing Address - Fax:209-466-7153
Practice Address - Street 1:801 S HAM LN STE S
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95242-7503
Practice Address - Country:US
Practice Address - Phone:209-366-2616
Practice Address - Fax:209-333-3884
Is Sole Proprietor?:No
Enumeration Date:2011-04-05
Last Update Date:2018-02-13
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Provider Licenses
StateLicense IDTaxonomies
CAA151375207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology