Basic Information
Provider Information
NPI: 1629635016
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CHUN
FirstName: ARUM
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MD CANDIDATE
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3181 SW SAM JACKSON PARK RD
Address2:  
City: PORTLAND
State: OR
PostalCode: 972393011
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 601 ELMWOOD AVE
Address2:  
City: ROCHESTER
State: NY
PostalCode: 146423011
CountryCode: US
TelephoneNumber: 5857564800
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/21/2019
LastUpdateDate: 04/13/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 04/13/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
390200000X  Y Student, Health CareStudent in an Organized Health Care Education/Training Program 

No ID Information.


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