Provider Demographics
NPI:1851763783
Name:PUN, STACEY (MD)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:PUN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:6399 SAN IGNACIO AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95119-1215
Mailing Address - Country:US
Mailing Address - Phone:310-909-4728
Mailing Address - Fax:408-904-7730
Practice Address - Street 1:1127 WILSHIRE BLVD STE 600
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-3907
Practice Address - Country:US
Practice Address - Phone:213-278-0021
Practice Address - Fax:213-278-0973
Is Sole Proprietor?:No
Enumeration Date:2015-10-30
Last Update Date:2023-10-09
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Provider Licenses
StateLicense IDTaxonomies
CAA160550207N00000X, 207ZD0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology
No207N00000XAllopathic & Osteopathic PhysiciansDermatology