Provider Demographics
NPI:1548358393
Name:WAYNE B L CHUN MD LLC
Entity type:Organization
Organization Name:WAYNE B L CHUN MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:BL
Authorized Official - Last Name:CHUN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-852-8289
Mailing Address - Street 1:1351 S BERETANIA ST STE J
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-1825
Mailing Address - Country:US
Mailing Address - Phone:808-852-8289
Mailing Address - Fax:
Practice Address - Street 1:1351 S BERETANIA ST STE J
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-1825
Practice Address - Country:US
Practice Address - Phone:808-852-8289
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD 8858208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIH102010Medicare PIN
HIH87278Medicare UPIN