Provider Demographics
NPI:1033435243
Name:JACOB CHUN MD PA
Entity Type:Organization
Organization Name:JACOB CHUN MD PA
Other - Org Name:HUNT ORTHOPEDICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:
Authorized Official - Last Name:CHUN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-455-0300
Mailing Address - Street 1:4725 WELLINGTON ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75401-4945
Mailing Address - Country:US
Mailing Address - Phone:903-455-0300
Mailing Address - Fax:903-455-0301
Practice Address - Street 1:4221 RIDGECREST RD
Practice Address - Street 2:SUITE101
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75402-6017
Practice Address - Country:US
Practice Address - Phone:903-455-0300
Practice Address - Fax:903-455-0301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-13
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9146207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0077TMOtherBCBS GRP. NUMBER
TX1722159-02Medicaid
TX6408750001Medicare NSC
TXTXB103958Medicare PIN