Healthcare Provider Details

I. General information

NPI: 1831323039
Provider Name (Legal Business Name): JUN MO CHUNG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JUN MO JON CHUNG MD

II. Dates (important events)

Enumeration Date: 05/04/2009
Last Update Date: 10/29/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15TH MDG 755 SCOTT CIRCLE
JBPH-HICKAM HI
96853
US

IV. Provider business mailing address

PSC 3 BOX 8394
APO AP
96266-0084
US

V. Phone/Fax

Practice location:
  • Phone: 808-448-6377
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2011001611
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberRESIDENT
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: