Basic Information
| Provider Information | |||||||||
| NPI: | 1396777926 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHUN | ||||||||
| FirstName: | JONATHAN | ||||||||
| MiddleName: | SEHJIN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10000 SE MAIN ST STE 316 | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972162470 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032561575 | ||||||||
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| Practice Location | |||||||||
| Address1: | 505 NE 87TH AVE STE 301 | ||||||||
| Address2: | |||||||||
| City: | VANCOUVER | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986641965 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3605147374 | ||||||||
| FaxNumber: | 3605147384 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2006 | ||||||||
| LastUpdateDate: | 08/03/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208C00000X | BC61205873 | WA | Y | Allopathic & Osteopathic Physicians | Colon & Rectal Surgery | 208C00000X | MD176699 | OR | N | Allopathic & Osteopathic Physicians | Colon & Rectal Surgery | 208600000X | BC61205873 | WA | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | 49366 | WI | N | Allopathic & Osteopathic Physicians | Surgery | 208C00000X | 43060 | KY | N | Allopathic & Osteopathic Physicians | Colon & Rectal Surgery | 208600000X | D71895 | MD | N | Allopathic & Osteopathic Physicians | Surgery | 208C00000X | 2008017345 | MO | N | Allopathic & Osteopathic Physicians | Colon & Rectal Surgery |
ID Information
| ID | Type | State | Issuer | Description | 2059813 | 05 | WA | MEDICAID | 500705766 | 05 | OR | MEDICAID |