Provider Demographics
NPI:1063864742
Name:CHUN, BLAYSE
Entity Type:Individual
Prefix:
First Name:BLAYSE
Middle Name:
Last Name:CHUN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 S BERETANIA ST
Mailing Address - Street 2:SUITE #450
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-1870
Mailing Address - Country:US
Mailing Address - Phone:808-537-6688
Mailing Address - Fax:808-537-6689
Practice Address - Street 1:1401 S BERETANIA ST
Practice Address - Street 2:SUITE #450
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-1870
Practice Address - Country:US
Practice Address - Phone:808-537-6688
Practice Address - Fax:808-537-6689
Is Sole Proprietor?:No
Enumeration Date:2016-07-06
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI312225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant