Provider Demographics
NPI:1174003412
Name:SUN, SUSAN (DIPL OM (NCCAOM))
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:
Last Name:SUN
Suffix:
Gender:F
Credentials:DIPL OM (NCCAOM)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2939 S. WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67216
Mailing Address - Country:US
Mailing Address - Phone:316-293-8459
Mailing Address - Fax:833-340-7321
Practice Address - Street 1:2415 S GLENDALE ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67210-1202
Practice Address - Country:US
Practice Address - Phone:316-293-8459
Practice Address - Fax:833-340-7321
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-16
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011027169171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty