Provider Demographics
NPI:1396293619
Name:CHEN, I-CHUN (DPT)
Entity type:Individual
Prefix:
First Name:I-CHUN
Middle Name:
Last Name:CHEN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 DOVE ST
Mailing Address - Street 2:STE 100
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-2438
Mailing Address - Country:US
Mailing Address - Phone:989-424-6300
Mailing Address - Fax:989-424-6302
Practice Address - Street 1:1463 TREAT BLVD
Practice Address - Street 2:APT 1234
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94597-7513
Practice Address - Country:US
Practice Address - Phone:310-406-5864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-15
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL 0013581225100000X
TX1266381225100000X
IL070021878225100000X
CA292026225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist