Provider Demographics
NPI:1003376518
Name:SUN, ALLISSA LIYA (MD)
Entity Type:Individual
Prefix:
First Name:ALLISSA
Middle Name:LIYA
Last Name:SUN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1614 W. CENTRAL ROAD
Mailing Address - Street 2:SUITE 209
Mailing Address - City:ARLINGTON HTS.
Mailing Address - State:IL
Mailing Address - Zip Code:60005
Mailing Address - Country:US
Mailing Address - Phone:847-259-5070
Mailing Address - Fax:847-259-5322
Practice Address - Street 1:1614 W. CENTRAL ROAD
Practice Address - Street 2:SUITE 209
Practice Address - City:ARLINGTON HTS.
Practice Address - State:IL
Practice Address - Zip Code:60005
Practice Address - Country:US
Practice Address - Phone:847-259-5070
Practice Address - Fax:847-259-5322
Is Sole Proprietor?:No
Enumeration Date:2019-03-21
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036.161335208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics