Provider Demographics
NPI:1770997553
Name:CHUNG-HOON, EDWIN KAIWINUI (PT, PHD)
Entity type:Individual
Prefix:
First Name:EDWIN
Middle Name:KAIWINUI
Last Name:CHUNG-HOON
Suffix:
Gender:M
Credentials:PT, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1146 N 1170 E
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84097-4317
Mailing Address - Country:US
Mailing Address - Phone:801-380-5837
Mailing Address - Fax:
Practice Address - Street 1:1146 N 1170 E
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84097-4317
Practice Address - Country:US
Practice Address - Phone:801-380-5837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-19
Last Update Date:2014-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT120714-2401225100000X
CA18690225100000X
HI1358225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist