Provider Demographics
NPI:1144663386
Name:SUN, KRISTINE K (MD)
Entity type:Individual
Prefix:
First Name:KRISTINE
Middle Name:K
Last Name:SUN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KRSTINE
Other - Middle Name:KE
Other - Last Name:SUN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:5130 BRADENTON AVE STE A
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-7068
Mailing Address - Country:US
Mailing Address - Phone:614-734-1100
Mailing Address - Fax:614-734-1900
Practice Address - Street 1:5130 BRADENTON AVE STE A
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017
Practice Address - Country:US
Practice Address - Phone:614-734-1100
Practice Address - Fax:614-734-1900
Is Sole Proprietor?:No
Enumeration Date:2013-04-08
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.126565207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0183013Medicaid