Provider Demographics
NPI:1003000563
Name:RICHARD B. D. CHUN, M.D. PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:RICHARD B. D. CHUN, M.D. PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:B
Authorized Official - Last Name:CHUN
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:916-783-7118
Mailing Address - Street 1:729 SUNRISE AVE
Mailing Address - Street 2:STE 619
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-4548
Mailing Address - Country:US
Mailing Address - Phone:916-783-7118
Mailing Address - Fax:
Practice Address - Street 1:729 SUNRISE AVE
Practice Address - Street 2:STE 619
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-4548
Practice Address - Country:US
Practice Address - Phone:916-783-7118
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-28
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC28231207RG0100X, 261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA110233272OtherRAILROAD MEDICARE-PGBA
CA00C282310OtherBLUE SHIELD
CA00C282310Medicaid
CAC28231OtherBLUE CROSS
CAC28231OtherBLUE CROSS
CA00C282310Medicaid
CA00C282310Medicare PIN
CA110233272OtherRAILROAD MEDICARE-PGBA
CAE33595Medicare UPIN