Provider Demographics
NPI:1104824697
Name:CHUN, JOSEPH C (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:C
Last Name:CHUN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:CHOO-BONG
Other - Middle Name:
Other - Last Name:CHUN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 70211
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90070-0211
Mailing Address - Country:US
Mailing Address - Phone:213-944-7123
Mailing Address - Fax:213-483-7575
Practice Address - Street 1:3030 W OLYMPIC BLVD
Practice Address - Street 2:#217
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-6501
Practice Address - Country:US
Practice Address - Phone:213-944-7123
Practice Address - Fax:213-483-7575
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-08
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA31129207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A311291Medicaid
A26362Medicare UPIN
CA00A311291Medicaid