Provider Demographics
NPI:1134120496
Name:CHUN, YOON-TAEK (MD,FAAP)
Entity Type:Individual
Prefix:DR
First Name:YOON-TAEK
Middle Name:
Last Name:CHUN
Suffix:
Gender:M
Credentials:MD,FAAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:263 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:E STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301-2943
Mailing Address - Country:US
Mailing Address - Phone:570-421-3575
Mailing Address - Fax:
Practice Address - Street 1:263 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:E STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-2943
Practice Address - Country:US
Practice Address - Phone:570-421-3575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD030828E2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00947786Medicaid