1063890036 NPI number — ALBERT SHAN-CHING SUN ESTATE CHEN CHIH SUN, PER REP

Table of content: (NPI 1063890036)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063890036 NPI number — ALBERT SHAN-CHING SUN ESTATE CHEN CHIH SUN, PER REP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALBERT SHAN-CHING SUN ESTATE CHEN CHIH SUN, PER REP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1063890036
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/11/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 9766
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TOWSON
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21284
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-877-1733
Provider Business Mailing Address Fax Number:
410-877-1733

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1200 TEMFIELD RD.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TOWSON
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21286
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-877-1733
Provider Business Practice Location Address Fax Number:
410-877-1733
Provider Enumeration Date:
05/11/2015

Additional Information

Authorized Official

Authorized Official Last Name:
SUN
Authorized Official First Name:
CHEN-CHIH
Authorized Official Middle Name:
JANE
Authorized Official Title or Position:
PERSONAL REPRESENTATIVE
Authorized Official Telephone Number:
410-583-6817

Provider Taxonomy Codes

  • Taxonomy code: 207RP1001X , with the licence number:  MD0018779 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: MD0018779 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 25075100 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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