Provider Demographics
NPI:1982941951
Name:SUN AE WON
Entity Type:Organization
Organization Name:SUN AE WON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHANG
Authorized Official - Middle Name:SOON
Authorized Official - Last Name:CHOI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-775-2344
Mailing Address - Street 1:3550 W 8TH ST STE 304
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90005-2991
Mailing Address - Country:US
Mailing Address - Phone:323-775-2344
Mailing Address - Fax:213-559-8909
Practice Address - Street 1:3550 W 8TH ST STE 304
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90005-2991
Practice Address - Country:US
Practice Address - Phone:323-775-2344
Practice Address - Fax:213-559-8909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-11
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC14837261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center