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NPI Code Detail

MEDICARE: MR. THEAR CHUM

MEDICARE: MR. THEAR CHUM
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker113829CA

General Provider Information

NPI Number : 1134648231
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. THEAR CHUM
Provider Business Mailing Address
First Line : 1142 PONCE DE LEON AVE
Second Line :
City : STOCKTON
State : CA
Zip : 95209-2620
Country : US
Telephone Number : 209-242-3013
Fax Number :
Provider Business Practice Location Address
First Line : 1141 LEVER BLVD
Second Line :
City : STOCKTON
State : CA
Zip : 95206-2855
Country : US
Telephone Number : 209-479-3951
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/11/2017
Last Update Date : 04/20/2026

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