1245819754 NPI number — SUNKAN,LLC

Table of content: IAN WEBSTER RADLOFF FNP-BC (NPI 1932940319)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245819754 NPI number — SUNKAN,LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUNKAN,LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245819754
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/03/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5027 S CENTENNIAL CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ONTARIO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91762-7207
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
626-616-9040
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18475 COLIMA RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROWLAND HEIGHTS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91748-2805
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-616-9040
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/03/2021

Additional Information

Authorized Official

Authorized Official Last Name:
KAN
Authorized Official First Name:
SIZHUO
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
626-616-9040

Provider Taxonomy Codes

  • Taxonomy code: 156FX1800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: F8121196 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: F8121196 . This is a "EYEMED" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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