Provider Demographics
NPI:1972183820
Name:CHUNG, TIFFANY (PT, DPT)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:CHUNG
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2675 FLETCHER PKWY APT 40
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-2142
Mailing Address - Country:US
Mailing Address - Phone:917-232-1312
Mailing Address - Fax:
Practice Address - Street 1:5333 MISSION CENTER RD STE 100
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-1347
Practice Address - Country:US
Practice Address - Phone:619-295-3355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-13
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA300008208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation