Provider Demographics
NPI:1619152824
Name:WAI, CHUN-NAM (DO)
Entity Type:Individual
Prefix:DR
First Name:CHUN-NAM
Middle Name:
Last Name:WAI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:EDDIE
Other - Middle Name:CHUN-NAM
Other - Last Name:WAI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:19636 N 27TH AVE
Mailing Address - Street 2:SUITE 308
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-4013
Mailing Address - Country:US
Mailing Address - Phone:623-780-1999
Mailing Address - Fax:623-516-0950
Practice Address - Street 1:19636 N 27TH AVE
Practice Address - Street 2:SUITE 308
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-4013
Practice Address - Country:US
Practice Address - Phone:623-780-1999
Practice Address - Fax:623-516-0950
Is Sole Proprietor?:No
Enumeration Date:2008-01-07
Last Update Date:2009-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2110207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ119554Medicare PIN
AZD47190Medicare UPIN