Provider Demographics
NPI:1467473918
Name:CHUN, JENNIFER CHIANG (DPT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:CHIANG
Last Name:CHUN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26522 LA ALAMEDA
Mailing Address - Street 2:SUITE 120
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-6330
Mailing Address - Country:US
Mailing Address - Phone:949-282-1600
Mailing Address - Fax:949-367-0518
Practice Address - Street 1:27882 FORBES RD
Practice Address - Street 2:SUITE 110
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-1267
Practice Address - Country:US
Practice Address - Phone:949-364-2955
Practice Address - Fax:949-364-1799
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT34170225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAS283ZMedicare PIN