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NPI Code Detail

MEDICARE: ERICH CHUNG PT, DPT, OCS

MEDICARE: ERICH CHUNG PT, DPT, OCS
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
12251X0800XOrthopedic Physical TherapistPT37911CA

General Provider Information

NPI Number : 1902207541
Entity Type Code : Individual
Provider Name (Legal Business Name) : ERICH CHUNG PT, DPT, OCS
Provider Business Mailing Address
First Line : 422 S 4TH ST
Second Line :
City : ALHAMBRA
State : CA
Zip : 91801-3738
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2560 COLORADO BLVD
Second Line :
City : EAGLE ROCK
State : CA
Zip : 90041-1005
Country : US
Telephone Number : 323-255-5409
Fax Number : 323-255-5732
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/15/2014
Last Update Date : 09/15/2014

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