Provider Demographics
NPI:1245819754
Name:SUNKAN,LLC
Entity type:Organization
Organization Name:SUNKAN,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SIZHUO
Authorized Official - Middle Name:
Authorized Official - Last Name:KAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-616-9040
Mailing Address - Street 1:5027 S CENTENNIAL CIR
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91762-7207
Mailing Address - Country:US
Mailing Address - Phone:626-616-9040
Mailing Address - Fax:
Practice Address - Street 1:18475 COLIMA RD
Practice Address - Street 2:
Practice Address - City:ROWLAND HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91748-2805
Practice Address - Country:US
Practice Address - Phone:626-616-9040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-03
Last Update Date:2021-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF8121196Medicaid
CAF8121196OtherEYEMED