Provider Demographics
NPI:1851879829
Name:CHUN, MICHELLE MI (CPO)
Entity Type:Individual
Prefix:MISS
First Name:MICHELLE
Middle Name:MI
Last Name:CHUN
Suffix:
Gender:F
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 S AKERS ST STE 230
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-8307
Mailing Address - Country:US
Mailing Address - Phone:559-732-3957
Mailing Address - Fax:
Practice Address - Street 1:820 S AKERS ST STE 230
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277-8307
Practice Address - Country:US
Practice Address - Phone:559-732-3957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-01
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACPO03921335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier