MEDICARE: CHUN DIAGNOSTIC CLINIC, PLLC

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
1	207RI0200X	Infectious Disease Physician
2	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1205083458
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHUN DIAGNOSTIC CLINIC, PLLC

Provider Business Mailing Address
First Line	:	PO BOX 9
Second Line	:
City	:	PINELAND
State	:	TX
Zip	:	75968-0009
Country	:	US
Telephone Number	:	409-584-9933
Fax Number	:	409-584-1754

Provider Business Practice Location Address
First Line	:	103 TIMBERLAND HIGHWAY WEST
Second Line	:
City	:	PINELAND
State	:	TX
Zip	:	75968-0009
Country	:	US
Telephone Number	:	409-584-9933
Fax Number	:	409-584-1754

Authorized Official
Title or Position	:	OWNER
Name	:	DR. DUKJA CHUN
Credential	:	M.D.
Telephone Number	:	409-584-9933

Provider Enumeration Date	:	08/19/2008
Last Update Date	:	08/19/2008

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