Provider Demographics
NPI:1700836558
Name:CHUN, DOREEN SZE-MAN (DO)
Entity Type:Individual
Prefix:DR
First Name:DOREEN
Middle Name:SZE-MAN
Last Name:CHUN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 ROUTE 73 S
Mailing Address - Street 2:SUITE 307A
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4141
Mailing Address - Country:US
Mailing Address - Phone:856-983-9666
Mailing Address - Fax:856-983-2662
Practice Address - Street 1:750 ROUTE 73 S
Practice Address - Street 2:SUITE 307A
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-4141
Practice Address - Country:US
Practice Address - Phone:856-983-9666
Practice Address - Fax:856-983-2662
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB06877800208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJH08402Medicare UPIN