Provider Demographics
NPI:1811233661
Name:SUNSET PSYCHIATRIC MEDICAL CENTER
Entity type:Organization
Organization Name:SUNSET PSYCHIATRIC MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:626-813-1222
Mailing Address - Street 1:933 S SUNSET AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-3410
Mailing Address - Country:US
Mailing Address - Phone:626-813-1222
Mailing Address - Fax:626-813-1221
Practice Address - Street 1:933 S SUNSET AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-3410
Practice Address - Country:US
Practice Address - Phone:626-813-1222
Practice Address - Fax:626-813-1221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-26
Last Update Date:2012-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY21007305R00000X, 313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
No305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAQ634AMedicare UPIN