Provider Demographics
NPI:1528952124
Name:CHUNG, NOLAN E (PT, DPT)
Entity type:Individual
Prefix:
First Name:NOLAN
Middle Name:E
Last Name:CHUNG
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5050 COLDWATER CANYON AVE APT 207
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91423-1651
Mailing Address - Country:US
Mailing Address - Phone:808-387-7582
Mailing Address - Fax:
Practice Address - Street 1:10339 OSO AVE
Practice Address - Street 2:
Practice Address - City:CHATSWORTH
Practice Address - State:CA
Practice Address - Zip Code:91311-2542
Practice Address - Country:US
Practice Address - Phone:808-387-7582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-06
Last Update Date:2025-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA304447225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist