Provider Demographics
NPI:1972609519
Name:CHUN, BERNARD K (MD)
Entity Type:Individual
Prefix:
First Name:BERNARD
Middle Name:K
Last Name:CHUN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 25668
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96825-0668
Mailing Address - Country:US
Mailing Address - Phone:808-536-0300
Mailing Address - Fax:808-536-0320
Practice Address - Street 1:1329 LUSITANA ST STE 102
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2401
Practice Address - Country:US
Practice Address - Phone:808-533-4949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI4018207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI04710101Medicaid
HIH0000BDPKVMedicare PIN