MEDICARE: DR. WHA JIN (TERRY) CHUN O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	TUV6153-1	NY

General Provider Information

NPI Number	:	1639317126
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WHA JIN (TERRY) CHUN O.D.

Provider Business Mailing Address
First Line	:	240 W 102ND ST APT 41
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10025-4925
Country	:	US
Telephone Number	:	917-225-3766
Fax Number	:

Provider Business Practice Location Address
First Line	:	240 W 102ND ST APT 41
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10025-4925
Country	:	US
Telephone Number	:	917-225-3766
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/22/2009
Last Update Date	:	01/22/2009

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