Provider Demographics
NPI:1942208335
Name:CHI, WAN CHUNG (MD)
Entity Type:Individual
Prefix:DR
First Name:WAN
Middle Name:CHUNG
Last Name:CHI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:268 BUSH ST
Mailing Address - Street 2:3401
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94104-3503
Mailing Address - Country:US
Mailing Address - Phone:415-353-6539
Mailing Address - Fax:415-591-5845
Practice Address - Street 1:900 HYDE ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-4806
Practice Address - Country:US
Practice Address - Phone:415-353-6539
Practice Address - Fax:415-591-5845
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-11
Last Update Date:2016-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA76199208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A761990Medicaid
CAI24304Medicare UPIN
CA00A761993Medicare ID - Type Unspecified
CA00A761990Medicaid
CA00A761990Medicare ID - Type Unspecified