Provider Demographics
NPI:1396777926
Name:CHUN, JONATHAN SEHJIN (MD)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:SEHJIN
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 1:10000 SE MAIN ST STE 316
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97216-2470
Mailing Address - Country:US
Mailing Address - Phone:503-256-1575
Mailing Address - Fax:
Practice Address - Street 1:10000 SE MAIN ST STE 316
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-2470
Practice Address - Country:US
Practice Address - Phone:503-256-1575
Practice Address - Fax:503-253-9848
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WABC61205873208600000X, 208C00000X
WI49366208600000X
MDD71895208600000X
ORMD176699208C00000X, 208600000X
KY43060208C00000X
MO2008017345208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2059813Medicaid
OR500705766Medicaid
OR500705766Medicaid
OR187359Medicare PIN
WA2059813Medicaid