Provider Demographics
NPI:1487646857
Name:CLARKSON, CHUNJAI POWELL (MD)
Entity Type:Individual
Prefix:DR
First Name:CHUNJAI
Middle Name:POWELL
Last Name:CLARKSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CHUNJAI
Other - Middle Name:LEE
Other - Last Name:CLARKSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:11 TECHNOLOGY DR
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-2302
Mailing Address - Country:US
Mailing Address - Phone:949-923-3277
Mailing Address - Fax:855-812-5865
Practice Address - Street 1:145 THUNDER DR 2ND
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92083-6010
Practice Address - Country:US
Practice Address - Phone:760-941-1440
Practice Address - Fax:760-630-5477
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG73471207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB222707Medicare PIN