Provider Demographics
NPI:1437757135
Name:WANG, GLORIA CHUNG RUNG (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MS
First Name:GLORIA
Middle Name:CHUNG RUNG
Last Name:WANG
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:MS
Other - First Name:CHUNG
Other - Middle Name:RUNG
Other - Last Name:WANG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHYSICAL THERAPIST
Mailing Address - Street 1:1478 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94122-3230
Mailing Address - Country:US
Mailing Address - Phone:415-941-1518
Mailing Address - Fax:
Practice Address - Street 1:1355 ELLIS ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-4215
Practice Address - Country:US
Practice Address - Phone:415-567-2967
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-14
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13144225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist