Provider Demographics
NPI:1962512954
Name:CHUN, ANDREA MIEKO
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:MIEKO
Last Name:CHUN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11644
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96828-0644
Mailing Address - Country:US
Mailing Address - Phone:808-462-2968
Mailing Address - Fax:808-442-1419
Practice Address - Street 1:2228 LILIHA ST STE 404
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-1654
Practice Address - Country:US
Practice Address - Phone:808-462-2968
Practice Address - Fax:808-442-1419
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI34821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical