Provider Demographics
NPI:1700064243
Name:SUN MEDICAL CORPORATION
Entity Type:Organization
Organization Name:SUN MEDICAL CORPORATION
Other - Org Name:SUN MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES (JIM, JIMMY)
Authorized Official - Middle Name:JYH-MING
Authorized Official - Last Name:SUN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-692-2629
Mailing Address - Street 1:5475 E LA PALMA AVE
Mailing Address - Street 2:STE 209
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92807-2075
Mailing Address - Country:US
Mailing Address - Phone:714-637-1900
Mailing Address - Fax:866-551-6625
Practice Address - Street 1:5475 E LA PALMA AVE
Practice Address - Street 2:STE 209
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92807-2075
Practice Address - Country:US
Practice Address - Phone:714-637-1900
Practice Address - Fax:866-551-6625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-06
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA72737207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Single Specialty