1104888221 NPI number — DR. LILI KUNG MD

Table of content: DR. LILI KUNG MD (NPI 1104888221)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104888221 NPI number — DR. LILI KUNG MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KUNG
Provider First Name:
LILI
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104888221
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/22/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
933 MAMAORNECK AVE
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
MAMARONECK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10543-1661
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-630-1800
Provider Business Mailing Address Fax Number:
914-630-2139

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
933 MAMAORNECK AVE
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
MAMARONECK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10543-1661
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-630-1800
Provider Business Practice Location Address Fax Number:
914-630-2139
Provider Enumeration Date:
04/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  218148 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0D2971 . This is a "EMPIRE BC/BS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 11146589 . This is a "MULTIPLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 397819 . This is a "CONNECTICARES" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1981466 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 02222493 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2423333 . This is a "AETNA HMO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 218148-1 . This is a "HIP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2C7597 . This is a "HEALTHNET" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P2090832 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0007937147 . This is a "AETNA PPO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: CFP2181485 . This is a "WORKERS COMPENSATION" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000092694 . This is a "BETTER HEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 5998815 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 9457506003 . This is a "CIGNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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