MEDICARE: DR. JASON YI CHEN HUNG DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT293645	CA

General Provider Information

NPI Number	:	1396255089
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JASON YI CHEN HUNG DPT

Provider Business Mailing Address
First Line	:	2251 YUCCA AVE
Second Line	:
City	:	FULLERTON
State	:	CA
Zip	:	92835-3319
Country	:	US
Telephone Number	:	714-749-0192
Fax Number	:

Provider Business Practice Location Address
First Line	:	808 ADAMS AVE
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92648-3214
Country	:	US
Telephone Number	:	714-749-0192
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/06/2017
Last Update Date	:	10/06/2017

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