Provider Demographics
NPI:1063773950
Name:CHUNG, ALICE (DPT)
Entity type:Individual
Prefix:
First Name:ALICE
Middle Name:
Last Name:CHUNG
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:ALICE
Other - Middle Name:
Other - Last Name:TING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:1811 S MAYFLOWER AVE
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91016-4701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:214 S ATLANTIC BLVD
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-3257
Practice Address - Country:US
Practice Address - Phone:626-863-1224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-06
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38802225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist