Provider Demographics
NPI:1801816137
Name:TERUYA, JUN (MD DSC)
Entity Type:Individual
Prefix:PROF
First Name:JUN
Middle Name:
Last Name:TERUYA
Suffix:
Gender:M
Credentials:MD DSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6621 FANNIN ST
Mailing Address - Street 2:SUITE WB1100
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2303
Mailing Address - Country:US
Mailing Address - Phone:832-824-1879
Mailing Address - Fax:832-825-5858
Practice Address - Street 1:6621 FANNIN ST
Practice Address - Street 2:SUITE WB1100
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2303
Practice Address - Country:US
Practice Address - Phone:832-824-1879
Practice Address - Fax:832-825-5858
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4754207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX154018902OtherCIDC
TX154018901Medicaid
TX8038J3Medicare PIN
G62394Medicare UPIN
TXP00020832Medicare PIN