Provider Demographics
NPI:1033194246
Name:CHUN, JACOB (MD)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:
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 1:4725 WELLINGTON ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75401-4945
Mailing Address - Country:US
Mailing Address - Phone:903-455-0300
Mailing Address - Fax:903-455-0301
Practice Address - Street 1:4725 WELLINGTON ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75401-4945
Practice Address - Country:US
Practice Address - Phone:903-455-0300
Practice Address - Fax:903-455-0301
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2019-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9146207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8CJ777OtherBCBS IND. NUMBER
TX214090701Medicaid
TX8CJ777OtherBCBS IND. NUMBER
TX6408750001Medicare NSC
TX214090701Medicaid