Provider Demographics
NPI:1720053580
Name:KUNG, ANDREW LI JEN (MD PHD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:LI JEN
Last Name:KUNG
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 BINNEY ST
Mailing Address - Street 2:MAYER 649
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115
Mailing Address - Country:US
Mailing Address - Phone:617-632-5731
Mailing Address - Fax:617-582-8096
Practice Address - Street 1:44 BINNEY ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115
Practice Address - Country:US
Practice Address - Phone:617-632-5731
Practice Address - Fax:617-582-8096
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1508072080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
47199OtherFALLON COMMUNITY HEALTH P
150807OtherTUFTS
2929488OtherAETNA US HEALTHCARE
900002559OtherRR MEDICARE DFCI
3390960OtherCIGNA
J19982OtherMASSACHUSETTS BCBS
14375DFOtherHPHC DFCI ONLY
MA3194191Medicaid
90794Medicare UPIN