Provider Demographics
NPI:1841488418
Name:MIEN - DOOR KIOUNE, MD
Entity type:Organization
Organization Name:MIEN - DOOR KIOUNE, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING STAFF/OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TSUI-MEI
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:410-669-1290
Mailing Address - Street 1:42 SPRINGHILL FARM CT
Mailing Address - Street 2:
Mailing Address - City:COCKEYSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21030-1400
Mailing Address - Country:US
Mailing Address - Phone:410-669-1290
Mailing Address - Fax:
Practice Address - Street 1:821 N EUTAW ST
Practice Address - Street 2:SUITE 206
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-4648
Practice Address - Country:US
Practice Address - Phone:410-669-1290
Practice Address - Fax:410-383-2228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0031865207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD994650100Medicaid
MD387LMedicare PIN
MD994650100Medicaid