Healthcare Provider Details

I. General information

NPI: 1518156637
Provider Name (Legal Business Name): JINSOO CHUN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2007
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 POND ST
NORWELL MA
02061-1627
US

IV. Provider business mailing address

50 MILL ST UNIT C
QUINCY MA
02169-5653
US

V. Phone/Fax

Practice location:
  • Phone: 781-421-6182
  • Fax:
Mailing address:
  • Phone: 734-709-6602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1911
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: