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NPI Code Detail

MEDICARE: DR. SUSAN SUN DIPL. OM (NCCAOM)

MEDICARE: DR. SUSAN SUN DIPL. OM (NCCAOM)
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1171100000XAcupuncturist2011027169MO

General Provider Information

NPI Number : 1174003412
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SUSAN SUN DIPL. OM (NCCAOM)
Provider Business Mailing Address
First Line : 2939 S. WASHINGTON AVE
Second Line :
City : WICHITA
State : KS
Zip : 67216
Country : US
Telephone Number : 316-293-8459
Fax Number : 833-340-7321
Provider Business Practice Location Address
First Line : 2415 S GLENDALE ST
Second Line :
City : WICHITA
State : KS
Zip : 67210-1202
Country : US
Telephone Number : 316-293-8459
Fax Number : 833-340-7321
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/16/2018
Last Update Date : 08/16/2018

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