Provider Demographics
NPI:1528363512
Name:CHUNG, DANIELLE (CO)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:CHUNG
Suffix:
Gender:F
Credentials:CO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10490 CHADWELL DR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89521-4205
Mailing Address - Country:US
Mailing Address - Phone:949-637-4085
Mailing Address - Fax:
Practice Address - Street 1:10490 CHADWELL DR
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89521-4205
Practice Address - Country:US
Practice Address - Phone:949-637-4085
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-21
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO003169335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier