Provider Demographics
NPI:1750481560
Name:CHUN, ALLAN B (DOS)
Entity Type:Individual
Prefix:
First Name:ALLAN
Middle Name:B
Last Name:CHUN
Suffix:
Gender:M
Credentials:DOS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 HAMAKUA DR
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-3984
Mailing Address - Country:US
Mailing Address - Phone:808-432-3400
Mailing Address - Fax:
Practice Address - Street 1:201 HAMAKUA DR
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-3984
Practice Address - Country:US
Practice Address - Phone:808-432-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDOS-647207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI069167-01Medicaid
HIE93395Medicare UPIN
HI069167-01Medicaid