Provider Demographics
NPI:1700669538
Name:CHUNG, DEAN
Entity Type:Individual
Prefix:
First Name:DEAN
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 1:2 PETERS CANYON RD STE 100
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92606-1798
Mailing Address - Country:US
Mailing Address - Phone:949-679-3988
Mailing Address - Fax:
Practice Address - Street 1:7941 BEACH BLVD STE J
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90620-1900
Practice Address - Country:US
Practice Address - Phone:714-736-6855
Practice Address - Fax:714-736-6824
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-15
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA304446225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist