Provider Demographics
NPI:1285931782
Name:LI, CHUNG KAY (PA; RPT)
Entity type:Individual
Prefix:MR
First Name:CHUNG
Middle Name:KAY
Last Name:LI
Suffix:
Gender:M
Credentials:PA; RPT
Other - Prefix:MR
Other - First Name:WALTER
Other - Middle Name:CHUNG KAY
Other - Last Name:LI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA, RPT
Mailing Address - Street 1:PO BOX 1484
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93302-1484
Mailing Address - Country:US
Mailing Address - Phone:951-368-8308
Mailing Address - Fax:661-792-3095
Practice Address - Street 1:1004 14TH AVE
Practice Address - Street 2:
Practice Address - City:DELANO
Practice Address - State:CA
Practice Address - Zip Code:93215-2246
Practice Address - Country:US
Practice Address - Phone:661-474-2600
Practice Address - Fax:661-474-2600
Is Sole Proprietor?:No
Enumeration Date:2011-02-17
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA15269363AM0700X
CAPT8718225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical