Provider Demographics
NPI:1326555087
Name:LIFETREE INTERNAL MEDICINE
Entity Type:Organization
Organization Name:LIFETREE INTERNAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DONGJIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-868-9146
Mailing Address - Street 1:6405 WOODSONG CT
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-4122
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:24585 STONE CARVER DR STE 100
Practice Address - Street 2:
Practice Address - City:ALDIE
Practice Address - State:VA
Practice Address - Zip Code:20105-2798
Practice Address - Country:US
Practice Address - Phone:716-868-9146
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-03
Last Update Date:2018-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty