Provider Demographics
NPI:1801922422
Name:CHUN, LISA KIM (MD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:KIM
Last Name:CHUN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6191 EXECUTIVE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-3901
Mailing Address - Country:US
Mailing Address - Phone:301-231-9010
Mailing Address - Fax:301-770-6876
Practice Address - Street 1:6191 EXECUTIVE BLVD
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-3901
Practice Address - Country:US
Practice Address - Phone:301-231-9010
Practice Address - Fax:301-770-6876
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2008-04-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD00529472084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD003416D83Medicare PIN
MDG69768Medicare UPIN