Provider Demographics
NPI:1457832628
Name:CHEN, WAH WAH MAUNG (PT, DPT)
Entity Type:Individual
Prefix:
First Name:WAH WAH
Middle Name:MAUNG
Last Name:CHEN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 ORCHARD
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-4545
Mailing Address - Country:US
Mailing Address - Phone:949-419-5865
Mailing Address - Fax:
Practice Address - Street 1:14318 OHIO ST
Practice Address - Street 2:
Practice Address - City:BALDWIN PARK
Practice Address - State:CA
Practice Address - Zip Code:91706-2553
Practice Address - Country:US
Practice Address - Phone:626-960-1971
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-27
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA292851225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist