Provider Demographics
NPI:1740811314
Name:CHUN, WAYNE
Entity type:Individual
Prefix:
First Name:WAYNE
Middle Name:
Last Name:CHUN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 HERON DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:94565-1916
Mailing Address - Country:US
Mailing Address - Phone:510-610-4888
Mailing Address - Fax:
Practice Address - Street 1:265 HERON DR
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:CA
Practice Address - Zip Code:94565-1916
Practice Address - Country:US
Practice Address - Phone:925-439-2302
Practice Address - Fax:925-439-2302
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-31
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CATCH3651156F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156F00000XEye and Vision Services ProvidersTechnician/TechnologistGroup - Single Specialty