Provider Demographics
NPI:1598079683
Name:SUN ACUPUNCTURE INC.
Entity Type:Organization
Organization Name:SUN ACUPUNCTURE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:GROSAM
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:952-935-0600
Mailing Address - Street 1:723 MAINSTREET
Mailing Address - Street 2:
Mailing Address - City:HOPKINS
Mailing Address - State:MN
Mailing Address - Zip Code:55343-7624
Mailing Address - Country:US
Mailing Address - Phone:952-935-0600
Mailing Address - Fax:
Practice Address - Street 1:723 MAINSTREET
Practice Address - Street 2:
Practice Address - City:HOPKINS
Practice Address - State:MN
Practice Address - Zip Code:55343-7624
Practice Address - Country:US
Practice Address - Phone:952-935-0600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-30
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1456171100000X
MN1674225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty