Provider Demographics
NPI:1336673995
Name:CHAE, STEPHANIE HEE JUN (MD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:HEE JUN
Last Name:CHAE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:HEE JUN
Other - Middle Name:
Other - Last Name:CHAE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:17234 VALLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92335
Mailing Address - Country:US
Mailing Address - Phone:714-401-5824
Mailing Address - Fax:
Practice Address - Street 1:17234 VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335
Practice Address - Country:US
Practice Address - Phone:714-401-5824
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-20
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program