Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 11508 | MD |
N | 122300000X | Dentist | 5326 | DC |
N | 1223P0106X | Oral and Maxillofacial Pathology | 11508 | MD |
N | 1223P0106X | Oral and Maxillofacial Pathology | 5326 | DC |
NPI | 1851491310 |
---|---|
Provider Name | Dr. Di Sun |
First Address | Rockville, MD 20852 |
Second Address | Rockville, MD 20852 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5486025 | (05) | MD |
U61731 | (02) | MD |
X36809 | (02) | DC |