Healthcare Provider Details

I. General information

NPI: 1881505980
Provider Name (Legal Business Name): ALYSSIA CHUNG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 E WASHINGTON ST
COLTON CA
92324-8101
US

IV. Provider business mailing address

823 DAHLIA AVE
REDLANDS CA
92374-1411
US

V. Phone/Fax

Practice location:
  • Phone: 909-580-5000
  • Fax:
Mailing address:
  • Phone: 845-249-5692
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number32971
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: