Provider Demographics
NPI:1720210602
Name:JENQ, CHUNG BII R (RPT)
Entity Type:Individual
Prefix:MR
First Name:CHUNG BII
Middle Name:R
Last Name:JENQ
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22512 N SUMMIT RIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:CHATSWORTH
Mailing Address - State:CA
Mailing Address - Zip Code:91311-2672
Mailing Address - Country:US
Mailing Address - Phone:818-300-4190
Mailing Address - Fax:818-349-5230
Practice Address - Street 1:22512 N SUMMIT RIDGE CIR
Practice Address - Street 2:
Practice Address - City:CHATSWORTH
Practice Address - State:CA
Practice Address - Zip Code:91311-2672
Practice Address - Country:US
Practice Address - Phone:818-300-4190
Practice Address - Fax:818-349-5230
Is Sole Proprietor?:No
Enumeration Date:2009-08-11
Last Update Date:2009-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT15388225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist