Provider Demographics
NPI:1790988483
Name:JULIE K SUN MD, INC
Entity Type:Organization
Organization Name:JULIE K SUN MD, INC
Other - Org Name:JULIE K SUN, M.D., INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:
Authorized Official - First Name:ANGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:URBINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-571-6177
Mailing Address - Street 1:223 N GARFIELD AVE
Mailing Address - Street 2:#100
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754-1700
Mailing Address - Country:US
Mailing Address - Phone:626-571-6177
Mailing Address - Fax:
Practice Address - Street 1:223 N GARFIELD AVE
Practice Address - Street 2:#100
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-1700
Practice Address - Country:US
Practice Address - Phone:626-571-6177
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-08
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG720902471C3402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiographyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW19092Medicare ID - Type Unspecified