Provider Demographics
NPI:1932289170
Name:SUNDINE, MICHAEL J (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL J
Middle Name:
Last Name:SUNDINE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 STILLWATER
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92603-3426
Mailing Address - Country:US
Mailing Address - Phone:949-706-3100
Mailing Address - Fax:
Practice Address - Street 1:1401 AVOCADO AVE
Practice Address - Street 2:SUITE 501
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7720
Practice Address - Country:US
Practice Address - Phone:949-706-3100
Practice Address - Fax:949-706-3265
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA000000G66233208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF12019Medicare UPIN