Provider Demographics
NPI:1457892655
Name:SUN, KE (MD)
Entity Type:Individual
Prefix:
First Name:KE
Middle Name:
Last Name:SUN
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 1:5730 EXECUTIVE DR STE 230
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-1762
Mailing Address - Country:US
Mailing Address - Phone:703-259-9930
Mailing Address - Fax:
Practice Address - Street 1:9805 WOODLEIGH LN
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22032-4060
Practice Address - Country:US
Practice Address - Phone:703-259-9930
Practice Address - Fax:703-259-9940
Is Sole Proprietor?:No
Enumeration Date:2017-03-20
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD89988207R00000X
MEMD27851207R00000X
VA0101269909207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine