Provider Demographics
NPI:1225231491
Name:CHUANG, JERRY (MD)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:
Last Name:CHUANG
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 1:21088 BLOSSOM WAY
Mailing Address - Street 2:
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-3735
Mailing Address - Country:US
Mailing Address - Phone:412-657-7636
Mailing Address - Fax:
Practice Address - Street 1:113 WATERWORKS WAY STE 225
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3175
Practice Address - Country:US
Practice Address - Phone:714-525-5588
Practice Address - Fax:714-525-5193
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT183129208100000X
NMMD2009-0677208100000X
WAMD 60105559208100000X
CAA105856208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation