Healthcare Provider Details

I. General information

NPI: 1992898589
Provider Name (Legal Business Name): GARY P. CHUN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7565 MISSION VALLEY RD SUITE 200
SAN DIEGO CA
92108-4431
US

IV. Provider business mailing address

FILE# 54433
LOS ANGELES CA
90074
US

V. Phone/Fax

Practice location:
  • Phone: 619-245-2350
  • Fax: 858-784-5933
Mailing address:
  • Phone: 858-784-5767
  • Fax: 858-784-5933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG57586
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: