Provider Demographics
NPI:1578590899
Name:CHUN, G. MICHAEL GERARD (MD)
Entity Type:Individual
Prefix:
First Name:G. MICHAEL
Middle Name:GERARD
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 1:16200 SAND CANYON AVE
Mailing Address - Street 2:IRH DEPARTMENT OF RADIOLOGY
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-3714
Mailing Address - Country:US
Mailing Address - Phone:949-753-2365
Mailing Address - Fax:949-753-2368
Practice Address - Street 1:16200 SAND CANYON AVE
Practice Address - Street 2:IRH DEPARTMENT OF RADIOLOGY
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3714
Practice Address - Country:US
Practice Address - Phone:949-753-2365
Practice Address - Fax:949-753-2368
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA50023174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH91895Medicare UPIN