Provider Demographics
NPI:1104812643
Name:BYUN, EUGENE (MD)
Entity type:Individual
Prefix:
First Name:EUGENE
Middle Name:
Last Name:BYUN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E VALENCIA MESA DR STE 206
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-3817
Mailing Address - Country:US
Mailing Address - Phone:714-446-5050
Mailing Address - Fax:714-446-5150
Practice Address - Street 1:100 E VALENCIA MESA DR
Practice Address - Street 2:SUITE 206
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-3813
Practice Address - Country:US
Practice Address - Phone:714-446-5050
Practice Address - Fax:714-446-5150
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG82180207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG15841Medicare UPIN
CAWG82180AMedicare PIN