Provider Demographics
NPI:1184627366
Name:JUN, CYNTHIA HEEKYUNG (OD)
Entity type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:HEEKYUNG
Last Name:JUN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MRS
Other - First Name:CYNTHIA
Other - Middle Name:HEEKUNG
Other - Last Name:CHI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:826 WASHINGTON RD
Mailing Address - Street 2:STE 200
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-5750
Mailing Address - Country:US
Mailing Address - Phone:410-876-3333
Mailing Address - Fax:410-840-9133
Practice Address - Street 1:826 WASHINGTON RD
Practice Address - Street 2:STE 200
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-5750
Practice Address - Country:US
Practice Address - Phone:410-876-3333
Practice Address - Fax:410-840-9133
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA1471152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD4845680001Medicare NSC
MDU73348Medicare UPIN
MD230LMedicare PIN