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General NPI Number Information
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NPI Number | 1174263354
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Entity Type | Individual
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Provider Name | CASEY CHUNG
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Gender | Male
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Dates
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Enumeration Date | 03/29/2022
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Last Update Date | 03/29/2022
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Provider Practice Location Address
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Address Line | 26001 REDLANDS BLVD
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City | REDLANDS
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State | CA
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Zip | 92373-7762
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Country | US
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Telephone | 909-825-7084
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Fax |
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Provider Business Mailing Address
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Address Line | 11273 TERRA VISTA PKWY APT D
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-7417
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 226300000X
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Taxonomy Name | Kinesiotherapist
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License Number | 1901
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License Number State | CA
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