Provider Demographics
NPI:1164986618
Name:CHUN, BRAD MICHAEL (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:BRAD
Middle Name:MICHAEL
Last Name:CHUN
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:807 PUUIKENA DR
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96821-2564
Mailing Address - Country:US
Mailing Address - Phone:808-347-8059
Mailing Address - Fax:
Practice Address - Street 1:4211 WAIALAE AVE STE 111
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816-5300
Practice Address - Country:US
Practice Address - Phone:808-485-1177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-29
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT-27881223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics