Provider Demographics
NPI:1659387066
Name:SUN MEDICAL SERVICE CORP
Entity Type:Organization
Organization Name:SUN MEDICAL SERVICE CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LIANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-837-6368
Mailing Address - Street 1:2621 W HORIZON RIDGE PKWY
Mailing Address - Street 2:SUITE 150
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-2895
Mailing Address - Country:US
Mailing Address - Phone:702-837-6368
Mailing Address - Fax:702-837-0685
Practice Address - Street 1:2621 W HORIZON RIDGE PKWY
Practice Address - Street 2:SUITE 150
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-2895
Practice Address - Country:US
Practice Address - Phone:702-837-6368
Practice Address - Fax:702-837-0685
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV8518207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVCC1181OtherBLUECROSS BLUESHIELD
NVCC1181OtherBLUECROSS BLUESHIELD