MEDICARE: CHUNG OH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	299942	CA

General Provider Information

NPI Number	:	1962089342
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHUNG OH

Provider Business Mailing Address
First Line	:	13682 CHESTNUT ST
Second Line	:
City	:	WESTMINSTER
State	:	CA
Zip	:	92683-2630
Country	:	US
Telephone Number	:	808-253-1221
Fax Number	:

Provider Business Practice Location Address
First Line	:	441 OLD NEWPORT BLVD
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92663-4233
Country	:	US
Telephone Number	:	949-491-9991
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/24/2021
Last Update Date	:	03/24/2021

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Directions to “ CHUNG OH ” Practice Location

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