Provider Demographics
NPI:1962779942
Name:CHUN, KIL MO
Entity type:Individual
Prefix:DR
First Name:KIL
Middle Name:MO
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 1:75TH MEDICAL COMPANY
Mailing Address - Street 2:UNIT # 15021
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96218-5021
Mailing Address - Country:US
Mailing Address - Phone:315-764-5567
Mailing Address - Fax:
Practice Address - Street 1:75TH MEDICAL COMPANY
Practice Address - Street 2:UNIT # 15021
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96218-5021
Practice Address - Country:US
Practice Address - Phone:315-764-5567
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-19
Last Update Date:2011-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC1002710163WX0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0106XNursing Service ProvidersRegistered NurseOccupational Health