Provider Demographics
NPI:1497069215
Name:CHUNG, DENNIS MING TAK (PHD, BCBA-D)
Entity Type:Individual
Prefix:DR
First Name:DENNIS MING TAK
Middle Name:
Last Name:CHUNG
Suffix:
Gender:M
Credentials:PHD, BCBA-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3775 BEACON AVE
Mailing Address - Street 2:SUITE 208
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1465
Mailing Address - Country:US
Mailing Address - Phone:510-449-3386
Mailing Address - Fax:
Practice Address - Street 1:3775 BEACON AVE
Practice Address - Street 2:SUITE 208
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1465
Practice Address - Country:US
Practice Address - Phone:510-449-3386
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-04
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
CAPSY25206103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst