Provider Demographics
NPI:1912934555
Name:LI, CHUN-LUN JAMES (MD)
Entity Type:Individual
Prefix:
First Name:CHUN-LUN
Middle Name:JAMES
Last Name:LI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JAMES
Other - Middle Name:C
Other - Last Name:LI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 2625
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-8925
Mailing Address - Country:US
Mailing Address - Phone:914-222-0828
Mailing Address - Fax:212-343-1386
Practice Address - Street 1:128 MOTT ST
Practice Address - Street 2:SUITE 608
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-5540
Practice Address - Country:US
Practice Address - Phone:212-343-8399
Practice Address - Fax:212-343-1386
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-27
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY212717174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02199535Medicaid
NY5Q272Medicare PIN
NYH55553Medicare UPIN
NYWER871Medicare PIN