Provider Demographics
NPI:1457445124
Name:PYUNE, EDDIE C (MD)
Entity Type:Individual
Prefix:
First Name:EDDIE
Middle Name:C
Last Name:PYUNE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:EDWARD
Other - Middle Name:C
Other - Last Name:PYUNE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:12828 HARBOR BLVD
Mailing Address - Street 2:SUITE 230
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92840-5831
Mailing Address - Country:US
Mailing Address - Phone:714-741-4900
Mailing Address - Fax:714-741-4910
Practice Address - Street 1:12828 HARBOR BLVD
Practice Address - Street 2:SUITE 230
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92840-5831
Practice Address - Country:US
Practice Address - Phone:714-741-4900
Practice Address - Fax:714-741-4910
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA44458207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD71774Medicare UPIN
CAWA44458BMedicare PIN