Provider Demographics
NPI:1578528733
Name:JUN, IRENE H (MD)
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:H
Last Name:JUN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:IRENE
Other - Middle Name:H
Other - Last Name:PARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:300 PASTEUR DR
Mailing Address - Street 2:SUMC - PEDS PHYSICIAN BILLING MC: 5530
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94304-2203
Mailing Address - Country:US
Mailing Address - Phone:465-049-8739
Mailing Address - Fax:650-725-7888
Practice Address - Street 1:300 PASTEUR DR
Practice Address - Street 2:SUMC - PEDS PHYSICIAN BILLING MC: 5530
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-2203
Practice Address - Country:US
Practice Address - Phone:465-049-8739
Practice Address - Fax:650-725-7888
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA87966208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A879660Medicaid
CA00A879660Medicaid
CAI51879Medicare UPIN