=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154256113
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PAUL CHUN
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/12/2026
-----------------------------------------------------
Last Update Date | 06/12/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 251 W HARVARD BLVD
-----------------------------------------------------
City | SANTA PAULA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93060-3213
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-525-3375
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2048 MARCO DR
-----------------------------------------------------
City | CAMARILLO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93010-2436
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-377-9176
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 113110
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------