Provider Demographics
NPI:1942373865
Name:CHUN, DOUGLAS W (MD)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:W
Last Name:CHUN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1380 LUSITANA ST STE 412
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2440
Mailing Address - Country:US
Mailing Address - Phone:808-599-3780
Mailing Address - Fax:808-538-1672
Practice Address - Street 1:1380 LUSITANA ST STE 412
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2440
Practice Address - Country:US
Practice Address - Phone:808-599-3780
Practice Address - Fax:808-538-1672
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-5398207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0000078725OtherHMSA BILLING NUMBER
HI059267-01Medicaid
HIE58524Medicare UPIN
HIH0000BDRHNMedicare PIN