Provider Demographics
NPI:1003818055
Name:CHUN, RICHARD B D (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:B D
Last Name:CHUN
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 1:729 SUNRISE AVE
Mailing Address - Street 2:SUITE 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 1:7777 SUNRISE BLVD STE 2500
Practice Address - Street 2:
Practice Address - City:CITRUS HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:95610-2372
Practice Address - Country:US
Practice Address - Phone:916-737-5555
Practice Address - Fax:916-880-5430
Is Sole Proprietor?:No
Enumeration Date:2005-06-02
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC28231207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C282310OtherBLUE SHIELD
CAC28231OtherBLUE CROSS
CA952587937OtherBLUE CROSS
CA00C282310Medicaid
CA952587937OtherTIN--USED BY MANY INS CO
CA00C282310Medicare PIN
CA952587937OtherTIN--USED BY MANY INS CO
CA00C282310OtherBLUE SHIELD
CAE33595Medicare UPIN