Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0200X | Critical Care Medicine | 01082653A | IN |
N | 207RP1001X | Pulmonary Disease | 0101264998 | VA |
NPI | 1093154635 |
---|---|
Provider Name | Kevin Sun |
First Address | Fort Wayne, IN 46845-1701 |
Second Address | Fort Wayne, IN 46845-1701 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2013 |
Last Update Date | 16/12/2019 |