Provider Demographics
NPI:1265618631
Name:CHUNG, JAMES STEPHEN
Entity type:Individual
Prefix:
First Name:JAMES STEPHEN
Middle Name:
Last Name:CHUNG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8480 LIMEKILN PIKE
Mailing Address - Street 2:APT 606
Mailing Address - City:WYNCOTE
Mailing Address - State:PA
Mailing Address - Zip Code:19095-2801
Mailing Address - Country:US
Mailing Address - Phone:317-525-9968
Mailing Address - Fax:317-525-9968
Practice Address - Street 1:8480 LIMEKILN PIKE
Practice Address - Street 2:APT 606
Practice Address - City:WYNCOTE
Practice Address - State:PA
Practice Address - Zip Code:19095
Practice Address - Country:US
Practice Address - Phone:317-525-9968
Practice Address - Fax:317-525-9968
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-16
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01269800171W00000X
PAPT020292225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist