Provider Demographics
NPI:1609834159
Name:SUNRISE MEDICAL DIAGNOSTIC, INC
Entity Type:Organization
Organization Name:SUNRISE MEDICAL DIAGNOSTIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARINA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOKHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-972-4125
Mailing Address - Street 1:12611 N 103RD AVE
Mailing Address - Street 2:STE # G
Mailing Address - City:SUN CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85351-3422
Mailing Address - Country:US
Mailing Address - Phone:623-972-4125
Mailing Address - Fax:623-972-0265
Practice Address - Street 1:12611 N 103RD AVE
Practice Address - Street 2:STE # G
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-3422
Practice Address - Country:US
Practice Address - Phone:623-972-4125
Practice Address - Fax:623-972-0265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory