Provider Demographics
NPI:1093989139
Name:KENNEAL Y C CHUN MD LLC
Entity Type:Organization
Organization Name:KENNEAL Y C CHUN MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:
Authorized Official - First Name:GERMAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:LARIOZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-533-3368
Mailing Address - Street 1:1329 LUSITANA ST
Mailing Address - Street 2:SUITE 407
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2429
Mailing Address - Country:US
Mailing Address - Phone:808-533-3368
Mailing Address - Fax:808-536-4849
Practice Address - Street 1:1329 LUSITANA ST
Practice Address - Street 2:SUITE 407
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2429
Practice Address - Country:US
Practice Address - Phone:808-533-3368
Practice Address - Fax:808-536-4849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-18
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD3029207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI03783903Medicaid
HIB41588OtherHMSA
HIB41588OtherHMSA
HIH56000Medicare PIN
HI03783903Medicaid