Provider Demographics
NPI:1831412899
Name:PEI SUN MD.LLC
Entity type:Organization
Organization Name:PEI SUN MD.LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PEI
Authorized Official - Middle Name:FANG
Authorized Official - Last Name:SUN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-269-4353
Mailing Address - Street 1:850 N MAIN STREET EXT
Mailing Address - Street 2:BUILDING1,A3
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-2400
Mailing Address - Country:US
Mailing Address - Phone:203-269-4353
Mailing Address - Fax:203-269-4606
Practice Address - Street 1:850 N MAIN STREET EXT
Practice Address - Street 2:BUILDING1,A3
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492-2400
Practice Address - Country:US
Practice Address - Phone:203-269-4353
Practice Address - Fax:203-269-4606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-04
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT037546261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care