Provider Demographics
NPI:1063890036
Name:ALBERT SHAN-CHING SUN ESTATE CHEN CHIH SUN, PER REP
Entity type:Organization
Organization Name:ALBERT SHAN-CHING SUN ESTATE CHEN CHIH SUN, PER REP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PERSONAL REPRESENTATIVE
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHEN-CHIH
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:SUN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-583-6817
Mailing Address - Street 1:P.O. BOX 9766
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21284
Mailing Address - Country:US
Mailing Address - Phone:410-877-1733
Mailing Address - Fax:410-877-1733
Practice Address - Street 1:1200 TEMFIELD RD.
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286
Practice Address - Country:US
Practice Address - Phone:410-877-1733
Practice Address - Fax:410-877-1733
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALBERT SHAN-CHING SUN ESTATE CHEN CHIH SUN, PER REP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-05-11
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMD0018779207RP1001X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD25075100Medicaid
D77824Medicare Oscar/Certification