Provider Demographics
NPI:1003925272
Name:HALL, SUNG UN E (PA)
Entity Type:Individual
Prefix:MRS
First Name:SUNG UN
Middle Name:E
Last Name:HALL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:SOONY
Other - Middle Name:ELLEN
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA
Mailing Address - Street 1:9211 E 21ST ST N
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-2900
Mailing Address - Country:US
Mailing Address - Phone:316-609-4558
Mailing Address - Fax:316-609-4599
Practice Address - Street 1:9211 E 21ST ST N
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-2900
Practice Address - Country:US
Practice Address - Phone:316-609-4558
Practice Address - Fax:316-609-4599
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-01064363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200547600BMedicaid
KS426945Medicare PIN
KS0039719050Medicare Oscar/Certification
KS200547600BMedicaid