Healthcare Provider Details

I. General information

NPI: 1063890036
Provider Name (Legal Business Name): ALBERT SHAN-CHING SUN ESTATE CHEN CHIH SUN, PER REP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2015
Last Update Date: 05/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 TEMFIELD RD.
TOWSON MD
21286
US

IV. Provider business mailing address

P.O. BOX 9766
TOWSON MD
21284
US

V. Phone/Fax

Practice location:
  • Phone: 410-877-1733
  • Fax: 410-877-1733
Mailing address:
  • Phone: 410-877-1733
  • Fax: 410-877-1733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD0018779
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberMD0018779
License Number StateMD

VIII. Authorized Official

Name: MRS. CHEN-CHIH JANE SUN
Title or Position: PERSONAL REPRESENTATIVE
Credential: M.D.
Phone: 410-583-6817