Provider Demographics
NPI:1003599325
Name:CHUN, TRACY
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:CHUN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 N LARCHMONT BLVD STE 321
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90004-3025
Mailing Address - Country:US
Mailing Address - Phone:323-464-4458
Mailing Address - Fax:916-933-0871
Practice Address - Street 1:321 N LARCHMONT BLVD STE 825
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90004-6400
Practice Address - Country:US
Practice Address - Phone:323-464-4458
Practice Address - Fax:916-933-0871
Is Sole Proprietor?:No
Enumeration Date:2023-08-11
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA304445225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist