Provider Demographics
NPI:1437501715
Name:LAI NA TUNG
Entity Type:Organization
Organization Name:LAI NA TUNG
Other - Org Name:ALPHA DYNAMIC PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAI
Authorized Official - Middle Name:NA
Authorized Official - Last Name:TUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-474-2600
Mailing Address - Street 1:623 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DELANO
Mailing Address - State:CA
Mailing Address - Zip Code:93215-2933
Mailing Address - Country:US
Mailing Address - Phone:661-474-2600
Mailing Address - Fax:661-474-2601
Practice Address - Street 1:623 MAIN ST
Practice Address - Street 2:
Practice Address - City:DELANO
Practice Address - State:CA
Practice Address - Zip Code:93215-2933
Practice Address - Country:US
Practice Address - Phone:661-474-2600
Practice Address - Fax:661-474-2601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-11
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0000004481261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA221118Medicare Oscar/Certification