Provider Demographics
NPI:1811533037
Name:CHUN, PAUL
Entity type:Individual
Prefix:
First Name:PAUL
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 1:16816 RUGGIO RD
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-3573
Mailing Address - Country:US
Mailing Address - Phone:808-799-7322
Mailing Address - Fax:512-337-8225
Practice Address - Street 1:4810 GATTIS SCHOOL RD STE 120
Practice Address - Street 2:
Practice Address - City:HUTTO
Practice Address - State:TX
Practice Address - Zip Code:78634-2037
Practice Address - Country:US
Practice Address - Phone:808-799-7322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-22
Last Update Date:2019-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX35768122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist