Provider Demographics
NPI:1699066704
Name:CHUNG, ANGELA (MS, OTR/L, CHT)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:CHUNG
Suffix:
Gender:F
Credentials:MS, OTR/L, CHT
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:
Other - Last Name:PAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, OTR/L, CHT
Mailing Address - Street 1:15928 VENTURA BLVD STE 218
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-4413
Mailing Address - Country:US
Mailing Address - Phone:818-518-9709
Mailing Address - Fax:
Practice Address - Street 1:15928 VENTURA BLVD STE 218
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-4413
Practice Address - Country:US
Practice Address - Phone:818-518-9709
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-23
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13712225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist