Basic Information
| Provider Information | |||||||||
| NPI: | 1508441478 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SC CHUN MD, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 576649 | ||||||||
| Address2: | |||||||||
| City: | MODESTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953576649 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2098452553 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1878 E HATCH RD | ||||||||
| Address2: | |||||||||
| City: | MODESTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953515096 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2098452553 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/12/2021 | ||||||||
| LastUpdateDate: | 02/19/2022 | ||||||||
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| AuthorizedOfficialLastName: | CHUN | ||||||||
| AuthorizedOfficialFirstName: | SOO | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO/PSYCHIATRIST | ||||||||
| AuthorizedOfficialTelephone: | 4155160779 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 02/19/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.