Organization Active NPI

Lake Front Wound Care

  • Family Medicine Physician
  • San Juan Capistrano, CA
National Provider Identifier
1235073784
Registry record updated Apr 15, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
LAKE FRONT WOUND CARE
Practice address
31501 Rancho Viejo Rd Ste 102
San Juan Capistrano, CA 92675-1870
Phone
(702) 344-4996
Fax
(702) 240-6545
NPI assigned
Apr 15, 2026
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 15, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Sonny Su, MD
Title
MD
Phone
(702) 338-9500

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

31501 Rancho Viejo Rd Ste 102
San Juan Capistrano, CA 92675-1870

Mailing address

2451 Professional CT Ste 180
Las Vegas, NV 89128-0827
Phone (702) 344-4996

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1776211200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1776211200000",
    "number": "1235073784",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2451 PROFESSIONAL CT STE 180",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891280827",
            "telephone_number": "702-344-4996",
            "fax_number": "702-240-6545"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "31501 RANCHO VIEJO RD STE 102",
            "city": "SAN JUAN CAPISTRANO",
            "state": "CA",
            "postal_code": "926751870",
            "telephone_number": "702-344-4996",
            "fax_number": "702-240-6545"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE FRONT WOUND CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-04-15",
        "last_updated": "2026-04-15",
        "certification_date": "2026-04-15",
        "status": "A",
        "authorized_official_last_name": "SU",
        "authorized_official_first_name": "SONNY",
        "authorized_official_title_or_position": "MD",
        "authorized_official_telephone_number": "702-338-9500",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Juan Capistrano, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.