Healthcare Provider Details

I. General information

NPI: 1558734277
Provider Name (Legal Business Name): INGYU CHUN PH.D., AU.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2015
Last Update Date: 05/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 E EL CAMINO REAL
MOUNTAIN VIEW CA
94040
US

IV. Provider business mailing address

701 E EL CAMINO REAL
MOUNTAIN VIEW CA
94040-2833
US

V. Phone/Fax

Practice location:
  • Phone: 650-934-7900
  • Fax:
Mailing address:
  • Phone: 650-934-7900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAU3022
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: