=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023975018
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DR. NICHOLAS DUC CHUNG
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/09/2026
-----------------------------------------------------
Last Update Date | 01/09/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 405A S OXFORD VALLEY RD
-----------------------------------------------------
City | FAIRLESS HILLS
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19030-4202
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 267-874-6000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2001 DISSTON ST
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19149-1813
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | PT033800
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------