Provider Demographics
NPI:1538278205
Name:CHUN, SOO CHRISTINE (MD)
Entity type:Individual
Prefix:DR
First Name:SOO
Middle Name:CHRISTINE
Last Name:CHUN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 576649
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95357-6649
Mailing Address - Country:US
Mailing Address - Phone:209-517-8330
Mailing Address - Fax:209-491-7184
Practice Address - Street 1:1878 E HATCH RD
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95351-5002
Practice Address - Country:US
Practice Address - Phone:209-538-1496
Practice Address - Fax:209-538-9421
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2022-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA891892084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOOA891890Medicare PIN
CAI44153Medicare UPIN
CAOOA891892Medicare PIN