MEDICARE: MR. CHINGHSIEN NICHOLAS CHUNG MSOT, OTR/ L

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	225X00000X	Occupational Therapist	20582	CA

General Provider Information

NPI Number	:	1720612658
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHINGHSIEN NICHOLAS CHUNG MSOT, OTR/ L

Provider Business Mailing Address
First Line	:	5106 RED RIVER DR
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76017-2014
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5106 RED RIVER DR
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76017-2014
Country	:	US
Telephone Number	:	408-887-5871
Fax Number	:

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

Provider Enumeration Date	:	02/29/2020
Last Update Date	:	02/29/2020

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