Healthcare Provider Details

I. General information

NPI: 1437501715
Provider Name (Legal Business Name): LAI NA TUNG
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2016
Last Update Date: 04/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

623 MAIN ST
DELANO CA
93215-2933
US

IV. Provider business mailing address

623 MAIN ST
DELANO CA
93215-2933
US

V. Phone/Fax

Practice location:
  • Phone: 661-474-2600
  • Fax: 661-474-2601
Mailing address:
  • Phone: 661-474-2600
  • Fax: 661-474-2601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number0000004481
License Number StateCA

VIII. Authorized Official

Name: LAI NA TUNG
Title or Position: OWNER
Credential:
Phone: 661-474-2600