Provider Demographics
NPI:1104888221
Name:KUNG, LILI (MD)
Entity type:Individual
Prefix:DR
First Name:LILI
Middle Name:
Last Name:KUNG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:933 MAMAORNECK AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MAMARONECK
Mailing Address - State:NY
Mailing Address - Zip Code:10543-1661
Mailing Address - Country:US
Mailing Address - Phone:914-630-1800
Mailing Address - Fax:914-630-2139
Practice Address - Street 1:933 MAMAORNECK AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:MAMARONECK
Practice Address - State:NY
Practice Address - Zip Code:10543-1661
Practice Address - Country:US
Practice Address - Phone:914-630-1800
Practice Address - Fax:914-630-2139
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY218148207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0D2971OtherEMPIRE BC/BS
NY11146589OtherMULTIPLAN
NY397819OtherCONNECTICARES
NY1981466OtherUNITED HEALTHCARE
NY02222493Medicaid
NY2423333OtherAETNA HMO
NY218148-1OtherHIP
NY2C7597OtherHEALTHNET
NYP2090832OtherOXFORD
NY0007937147OtherAETNA PPO
NYCFP2181485OtherWORKERS COMPENSATION
NY000092694OtherBETTER HEALTH
NY5998815OtherGHI
NY9457506003OtherCIGNA
NY0D2971Medicare ID - Type UnspecifiedMEDICARE