MEDICARE: MS. DENISE M. CHUN MFT

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	106H00000X	Marriage & Family Therapist	4511	CA

General Provider Information

NPI Number	:	1407165855
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DENISE M. CHUN MFT

Provider Business Mailing Address
First Line	:	1798 A BAY ROAD
Second Line	:
City	:	EAST PALO ALTO
State	:	CA
Zip	:	94303-1512
Country	:	US
Telephone Number	:	650-617-7832
Fax Number	:

Provider Business Practice Location Address
First Line	:	1798 A BAY ROAD
Second Line	:
City	:	EAST PALO ALTO
State	:	CA
Zip	:	94303-1512
Country	:	US
Telephone Number	:	650-617-7832
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/04/2010
Last Update Date	:	10/04/2010

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