Provider Demographics
NPI:1104706506
Name:HUNG, WAN-CHEN (PT, DPT)
Entity type:Individual
Prefix:
First Name:WAN-CHEN
Middle Name:
Last Name:HUNG
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:CAMILLE
Other - Middle Name:
Other - Last Name:HUNG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:6587 MALLO DE RIGLOS WAY
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-3472
Mailing Address - Country:US
Mailing Address - Phone:347-543-6653
Mailing Address - Fax:
Practice Address - Street 1:1850 N RIVERSIDE AVE STE 240
Practice Address - Street 2:
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92376-8082
Practice Address - Country:US
Practice Address - Phone:909-258-2220
Practice Address - Fax:909-258-2102
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-05
Last Update Date:2025-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT308888225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist