Healthcare Provider Details

I. General information

NPI: 1528126745
Provider Name (Legal Business Name): TAO SUN O.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 S 1000 E #128
SALT LAKE CITY UT
84102-1428
US

IV. Provider business mailing address

160 S 1000 E # 128
SALT LAKE CITY UT
84102-1428
US

V. Phone/Fax

Practice location:
  • Phone: 801-355-8668
  • Fax: 801-322-2188
Mailing address:
  • Phone: 801-355-8668
  • Fax: 801-322-2188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number325195-1201
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: