Provider Demographics
NPI:1205083458
Name:CHUN DIAGNOSTIC CLINIC, PLLC
Entity type:Organization
Organization Name:CHUN DIAGNOSTIC CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DUKJA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHUN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:409-584-9933
Mailing Address - Street 1:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:PINELAND
Mailing Address - State:TX
Mailing Address - Zip Code:75968-0009
Mailing Address - Country:US
Mailing Address - Phone:409-584-9933
Mailing Address - Fax:409-584-1754
Practice Address - Street 1:103 TIMBERLAND HIGHWAY WEST
Practice Address - Street 2:
Practice Address - City:PINELAND
Practice Address - State:TX
Practice Address - Zip Code:75968-0009
Practice Address - Country:US
Practice Address - Phone:409-584-9933
Practice Address - Fax:409-584-1754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-19
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty