Provider Demographics
NPI:1063733756
Name:CHUNG EASTON, WAI WING (MA MARRIAGE AND FA)
Entity type:Individual
Prefix:
First Name:WAI WING
Middle Name:
Last Name:CHUNG EASTON
Suffix:
Gender:F
Credentials:MA MARRIAGE AND FA
Other - Prefix:
Other - First Name:VIVIAN
Other - Middle Name:
Other - Last Name:CHUNG EASTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2555 E COLORADO BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-6622
Mailing Address - Country:US
Mailing Address - Phone:626-701-0472
Mailing Address - Fax:213-225-0085
Practice Address - Street 1:2555 E COLORADO BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-6622
Practice Address - Country:US
Practice Address - Phone:626-701-0472
Practice Address - Fax:213-225-0085
Is Sole Proprietor?:No
Enumeration Date:2010-06-16
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA80003106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist