Healthcare Provider Details

I. General information

NPI: 1578734794
Provider Name (Legal Business Name): BERNARD K CHUN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2008
Last Update Date: 04/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1329 LUSITANA ST STE 102
HONOLULU HI
96813-2401
US

IV. Provider business mailing address

PO BOX 25668
HONOLULU HI
96825-0668
US

V. Phone/Fax

Practice location:
  • Phone: 808-533-4949
  • Fax:
Mailing address:
  • Phone: 808-536-0300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4018
License Number StateHI

VIII. Authorized Official

Name: BERNARD K CHUN
Title or Position: OWNER/SELF
Credential: MD
Phone: 808-533-4949