Basic Information
| Provider Information | |||||||||
| NPI: | 1235898644 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHUNG | ||||||||
| FirstName: | ALEX | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14 BAYBERRY | ||||||||
| Address2: | |||||||||
| City: | BUENA PARK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906204170 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5628333199 | ||||||||
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| Practice Location | |||||||||
| Address1: | 40 CENTERPOINTE DR | ||||||||
| Address2: | |||||||||
| City: | LA PALMA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906231028 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7145228020 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/13/2021 | ||||||||
| LastUpdateDate: | 12/25/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/25/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 301216 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.