Provider Demographics
NPI:1952470866
Name:TINA P CHUN MD LLC
Entity Type:Organization
Organization Name:TINA P CHUN MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TINA
Authorized Official - Middle Name:P
Authorized Official - Last Name:CHUN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-546-1199
Mailing Address - Street 1:PO BOX 354
Mailing Address - Street 2:
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-0354
Mailing Address - Country:US
Mailing Address - Phone:808-484-1169
Mailing Address - Fax:808-484-1168
Practice Address - Street 1:550 S BERETANIA ST
Practice Address - Street 2:SUITE 614
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2496
Practice Address - Country:US
Practice Address - Phone:808-546-1199
Practice Address - Fax:808-546-1177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-9474207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI08838404Medicaid
HI08838404Medicaid
HIG74343Medicare UPIN