Provider Demographics
NPI:1851719629
Name:JI, LUNAN (MD)
Entity Type:Individual
Prefix:
First Name:LUNAN
Middle Name:
Last Name:JI
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:PO BOX 198054
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-8054
Mailing Address - Country:US
Mailing Address - Phone:786-662-5610
Mailing Address - Fax:
Practice Address - Street 1:6200 SUNSET DR STE 604
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-4831
Practice Address - Country:US
Practice Address - Phone:786-662-5610
Practice Address - Fax:786-533-9980
Is Sole Proprietor?:No
Enumeration Date:2014-03-31
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME144150208800000X
NY296559208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology