Provider Demographics
NPI:1275797334
Name:CHUNG, ALICE HAE KYUNG
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:HAE KYUNG
Last Name:CHUNG
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 1:20 BROOKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:PLANDOME
Mailing Address - State:NY
Mailing Address - Zip Code:11030-1405
Mailing Address - Country:US
Mailing Address - Phone:516-869-5988
Mailing Address - Fax:
Practice Address - Street 1:325 GARFIELD PL
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-2351
Practice Address - Country:US
Practice Address - Phone:718-230-1180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-17
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015758225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist