Provider Demographics
NPI:1376986471
Name:HSU, JERRY CHUNG-FARN (DPT)
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:CHUNG-FARN
Last Name:HSU
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 1:12469 SABROSA LN
Mailing Address - Street 2:
Mailing Address - City:MIRA LOMA
Mailing Address - State:CA
Mailing Address - Zip Code:91752-7326
Mailing Address - Country:US
Mailing Address - Phone:949-735-4335
Mailing Address - Fax:
Practice Address - Street 1:12469 SABROSA LN
Practice Address - Street 2:
Practice Address - City:MIRA LOMA
Practice Address - State:CA
Practice Address - Zip Code:91752-7326
Practice Address - Country:US
Practice Address - Phone:949-735-4335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-09
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33034225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist