Healthcare Provider Details

I. General information

NPI: 1003376518
Provider Name (Legal Business Name): ALLISSA LIYA SUN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2019
Last Update Date: 08/26/2022
Certification Date: 08/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1614 W. CENTRAL ROAD SUITE 209
ARLINGTON HTS. IL
60005
US

IV. Provider business mailing address

1614 W. CENTRAL ROAD SUITE 209
ARLINGTON HTS. IL
60005
US

V. Phone/Fax

Practice location:
  • Phone: 847-259-5070
  • Fax: 847-259-5322
Mailing address:
  • Phone: 847-259-5070
  • Fax: 847-259-5322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036.161335
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: