1578528733 NPI number — IRENE H JUN MD

Table of content: IRENE H JUN MD (NPI 1578528733)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578528733 NPI number — IRENE H JUN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JUN
Provider First Name:
IRENE
Provider Middle Name:
H
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PARK
Provider Other First Name:
IRENE
Provider Other Middle Name:
H
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1578528733
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/27/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 PASTEUR DR
Provider Second Line Business Mailing Address:
SUMC - PEDS PHYSICIAN BILLING MC: 5530
Provider Business Mailing Address City Name:
PALO ALTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94304-2203
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
465-049-8739
Provider Business Mailing Address Fax Number:
650-725-7888

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 PASTEUR DR
Provider Second Line Business Practice Location Address:
SUMC - PEDS PHYSICIAN BILLING MC: 5530
Provider Business Practice Location Address City Name:
PALO ALTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94304-2203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
465-049-8739
Provider Business Practice Location Address Fax Number:
650-725-7888
Provider Enumeration Date:
04/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  A87966 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00A879660 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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