Basic Information
| Provider Information | |||||||||
| NPI: | 1376798470 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHAN | ||||||||
| FirstName: | CHUN | ||||||||
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| Credential: | MPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 403 HELEN DR | ||||||||
| Address2: | |||||||||
| City: | MILLBRAE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940301617 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4153056993 | ||||||||
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| Practice Location | |||||||||
| Address1: | 728 PACIFIC AVE STE 301 | ||||||||
| Address2: | |||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941334488 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4154333318 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/18/2008 | ||||||||
| LastUpdateDate: | 03/11/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/11/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2251X0800X | 24921 | CA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic | 225100000X | 24921 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.