Provider Demographics
NPI:1104908516
Name:CHUNG, TERESA LIAW I (PSYD)
Entity type:Individual
Prefix:DR
First Name:TERESA
Middle Name:LIAW
Last Name:CHUNG
Suffix:I
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:
Other - Last Name:LIAW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1242 3RD STREET PROMENADE
Mailing Address - Street 2:SUITE 208
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90401-1319
Mailing Address - Country:US
Mailing Address - Phone:201-406-9496
Mailing Address - Fax:
Practice Address - Street 1:1242 3RD STREET PROMENADE
Practice Address - Street 2:SUITE 208
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401-1319
Practice Address - Country:US
Practice Address - Phone:201-406-9496
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist