Provider Demographics
NPI:1245323674
Name:GOLD SUN YUAN INC
Entity type:Organization
Organization Name:GOLD SUN YUAN INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:TONY
Authorized Official - Middle Name:
Authorized Official - Last Name:TSE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:626-572-0800
Mailing Address - Street 1:201 W GARVEY AVE
Mailing Address - Street 2:STE 107
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754-7418
Mailing Address - Country:US
Mailing Address - Phone:626-572-0800
Mailing Address - Fax:626-572-8505
Practice Address - Street 1:201 W GARVEY AVE
Practice Address - Street 2:STE 107
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-7418
Practice Address - Country:US
Practice Address - Phone:626-572-0800
Practice Address - Fax:626-572-8505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-30
Last Update Date:2015-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CAPHY482993336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2113451OtherPK
CA1245323674Medicaid
CA1245323674Medicaid