Healthcare Provider Details

I. General information

NPI: 1427552900
Provider Name (Legal Business Name): JENNIFER SUN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2018
Last Update Date: 09/18/2024
Certification Date: 09/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4219 S WESTERN AVE
OKLAHOMA CITY OK
73109-3410
US

IV. Provider business mailing address

3001 QUAIL SPRINGS PKWY FL 5
OKLAHOMA CITY OK
73134-2640
US

V. Phone/Fax

Practice location:
  • Phone: 405-644-5256
  • Fax: 405-636-7946
Mailing address:
  • Phone: 405-644-5256
  • Fax: 405-636-7946

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number44066
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: