Provider Demographics
NPI:1053140293
Name:SUNRISE MED CLINIC INC
Entity type:Organization
Organization Name:SUNRISE MED CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:NAREK
Authorized Official - Middle Name:
Authorized Official - Last Name:HAKOBYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-484-0458
Mailing Address - Street 1:8133 SAN FERNANDO RD STE B1
Mailing Address - Street 2:
Mailing Address - City:SUN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91352-4065
Mailing Address - Country:US
Mailing Address - Phone:818-208-1077
Mailing Address - Fax:818-279-0816
Practice Address - Street 1:8133 SAN FERNANDO RD STE B1
Practice Address - Street 2:
Practice Address - City:SUN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91352-4065
Practice Address - Country:US
Practice Address - Phone:818-208-1077
Practice Address - Fax:818-279-0816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-27
Last Update Date:2024-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA147448OtherMEDICAL BOARD OF CALIFORNIA