Provider Demographics
NPI:1285805002
Name:CHIN, SUNG HO (OTR/L)
Entity type:Individual
Prefix:MR
First Name:SUNG
Middle Name:HO
Last Name:CHIN
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:MR
Other - First Name:SHANE
Other - Middle Name:SUNG
Other - Last Name:CHIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR/L
Mailing Address - Street 1:903 CRENSHAW BLVD
Mailing Address - Street 2:STE 301
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90019-1967
Mailing Address - Country:US
Mailing Address - Phone:626-375-0855
Mailing Address - Fax:
Practice Address - Street 1:903 CRENSHAW BLVD
Practice Address - Street 2:STE 301
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90019-1967
Practice Address - Country:US
Practice Address - Phone:626-375-0855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-19
Last Update Date:2019-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6757225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist