Provider Demographics
NPI:1518934298
Name:WUN, KIN K (MD)
Entity Type:Individual
Prefix:
First Name:KIN
Middle Name:K
Last Name:WUN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:CHESTERTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21620-1434
Mailing Address - Country:US
Mailing Address - Phone:410-778-3798
Mailing Address - Fax:410-778-3192
Practice Address - Street 1:415 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:CHESTERTOWN
Practice Address - State:MD
Practice Address - Zip Code:21620-1434
Practice Address - Country:US
Practice Address - Phone:410-778-3798
Practice Address - Fax:410-778-3192
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-02
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD21313207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD185341400Medicaid
MDE561-0001OtherBLUE CROSS FEDERAL
MD185341400Medicaid
MDB69857Medicare UPIN