Provider Demographics
NPI:1467511808
Name:CHUN, KENNETH KUEHN (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:KUEHN
Last Name:CHUN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43494 WOODWARD AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-5052
Mailing Address - Country:US
Mailing Address - Phone:248-338-8220
Mailing Address - Fax:248-338-0210
Practice Address - Street 1:43494 WOODWARD AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-5052
Practice Address - Country:US
Practice Address - Phone:248-338-8220
Practice Address - Fax:248-338-0210
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIKC038189207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1394062Medicaid
MI0M56780001Medicare ID - Type Unspecified
MI1394062Medicaid