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General NPI Number Information
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NPI Number | 1174003412
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Entity Type | Individual
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Provider Name | SUSAN SUN DIPL. OM (NCCAOM)
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Gender | Female
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Dates
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Enumeration Date | 08/16/2018
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Last Update Date | 08/16/2018
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Provider Practice Location Address
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Address Line | 2415 S GLENDALE ST
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City | WICHITA
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State | KS
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Zip | 67210-1202
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Country | US
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Telephone | 316-293-8459
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Fax | 833-340-7321
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Provider Business Mailing Address
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Address Line | 2939 S. WASHINGTON AVE
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City | WICHITA
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State | KS
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Zip | 67216
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Country | US
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Telephone | 316-293-8459
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Fax | 833-340-7321
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 2011027169
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License Number State | MO
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