Provider Demographics
NPI:1619156817
Name:CHUN, WESLEY BUNG HUNG (PT)
Entity Type:Individual
Prefix:MR
First Name:WESLEY
Middle Name:BUNG HUNG
Last Name:CHUN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18541 VINCENNES ST APT 207
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91324-2963
Mailing Address - Country:US
Mailing Address - Phone:818-727-0770
Mailing Address - Fax:
Practice Address - Street 1:7473 FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:TUJUNGA
Practice Address - State:CA
Practice Address - Zip Code:91042-2726
Practice Address - Country:US
Practice Address - Phone:818-723-7798
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-24
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 16291174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist