Healthcare Provider Details

I. General information

NPI: 1720510225
Provider Name (Legal Business Name): SUN BYUN DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2017
Last Update Date: 07/23/2024
Certification Date: 07/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

795 AQUAHART RD STE 125
GLEN BURNIE MD
21061-3905
US

IV. Provider business mailing address

795 AQUAHART RD STE 125
GLEN BURNIE MD
21061-3905
US

V. Phone/Fax

Practice location:
  • Phone: 410-768-0702
  • Fax:
Mailing address:
  • Phone: 410-768-0702
  • Fax: 410-768-0649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number01776
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number01176
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number01176
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: