MEDICARE: DR. KIKO SUN D.C.

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
1	111N00000X	Chiropractor	005743	GA

General Provider Information

NPI Number	:	1619060035
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KIKO SUN D.C.

Provider Business Mailing Address
First Line	:	1140 HAMMOND DR NE
Second Line	:	SUITE G-7100
City	:	ATLANTA
State	:	GA
Zip	:	30328-5338
Country	:	US
Telephone Number	:	770-677-9771
Fax Number	:	770-677-9791

Provider Business Practice Location Address
First Line	:	1140 HAMMOND DR NE
Second Line	:	SUITE G-7100
City	:	ATLANTA
State	:	GA
Zip	:	30328-5338
Country	:	US
Telephone Number	:	770-677-9771
Fax Number	:	770-677-9791

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/30/2006
Last Update Date	:	07/08/2007

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Directions to “ DR. KIKO SUN D.C.” Practice Location

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