Provider Demographics
NPI:1093446759
Name:CHUNG, JUSTIN HAN (DPT)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:HAN
Last Name:CHUNG
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11109 TAMBERLY LN
Mailing Address - Street 2:
Mailing Address - City:TUJUNGA
Mailing Address - State:CA
Mailing Address - Zip Code:91042-1274
Mailing Address - Country:US
Mailing Address - Phone:818-590-8976
Mailing Address - Fax:
Practice Address - Street 1:1111 N BRAND BLVD STE J&K
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91202-3070
Practice Address - Country:US
Practice Address - Phone:818-244-0468
Practice Address - Fax:818-244-7559
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-22
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA302544225100000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist