Provider Demographics
NPI:1942782453
Name:CHU, SEAN YUN (MAT, LAT, ATC)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:YUN
Last Name:CHU
Suffix:
Gender:M
Credentials:MAT, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3939 TANGLEWOOD LN APT 250
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79762-7113
Mailing Address - Country:US
Mailing Address - Phone:505-730-3851
Mailing Address - Fax:
Practice Address - Street 1:1800 E 42ND ST
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79762-5839
Practice Address - Country:US
Practice Address - Phone:505-730-3851
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-30
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT80162255A2300X
2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer