Provider Demographics
NPI:1942330105
Name:CHUN, CAROLYN (DPM)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:CHUN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1990 WESTWOOD BLVD STE 220
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-4674
Mailing Address - Country:US
Mailing Address - Phone:310-475-5377
Mailing Address - Fax:
Practice Address - Street 1:1990 WESTWOOD BLVD STE 220
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-4674
Practice Address - Country:US
Practice Address - Phone:310-475-5377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3776A213E00000X, 213ES0103X
CAE3776213ES0103X, 213ES0131X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E37760Medicaid
CAE3776AMedicare PIN
CAU22075Medicare UPIN
CAE3776Medicare PIN
CA000E37760Medicaid