Provider Demographics
NPI:1366746299
Name:JOSEPH C CHUN, MD, INC
Entity type:Organization
Organization Name:JOSEPH C CHUN, MD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LILIA
Authorized Official - Middle Name:F
Authorized Official - Last Name:DE JESUS
Authorized Official - Suffix:
Authorized Official - Credentials:N/A
Authorized Official - Phone:213-386-4222
Mailing Address - Street 1:PO BOX 70211
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90070-0211
Mailing Address - Country:US
Mailing Address - Phone:213-480-1475
Mailing Address - Fax:213-483-7575
Practice Address - Street 1:201 S ALVARADO ST STE 702
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-2390
Practice Address - Country:US
Practice Address - Phone:213-480-1475
Practice Address - Fax:213-483-7575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-06
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA31129207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A311291Medicaid
CA00A311291Medicaid