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General NPI Number Information
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NPI Number | 1205425337
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Entity Type | Individual
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Provider Name | KLANCY J CHUNG REGISTERED AMFT
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Gender | Female
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Dates
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Enumeration Date | 01/13/2021
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Last Update Date | 07/25/2024
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Provider Practice Location Address
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Address Line | 5755 OBERLIN DR STE 106
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City | SAN DIEGO
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State | CA
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Zip | 92121-4715
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Country | US
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Telephone | 619-736-0436
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Fax |
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Provider Business Mailing Address
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Address Line | 2530 RAYMELL DR
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City | SAN DIEGO
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State | CA
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Zip | 92123-3544
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 133954
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 812817
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License Number State | CA
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