Provider Demographics
NPI:1518131325
Name:CHUNG, CHRIS HYUNG (MPT)
Entity Type:Individual
Prefix:MR
First Name:CHRIS
Middle Name:HYUNG
Last Name:CHUNG
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3855 AVOCADO BLVD
Mailing Address - Street 2:#140
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91941-7382
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3855 AVOCADO BLVD
Practice Address - Street 2:#140
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91941-7382
Practice Address - Country:US
Practice Address - Phone:619-660-7916
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-14
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34620225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist