Provider Demographics
NPI:1720612658
Name:CHUNG, CHINGHSIEN NICHOLAS (MSOT, OTR/ L)
Entity type:Individual
Prefix:MR
First Name:CHINGHSIEN
Middle Name:NICHOLAS
Last Name:CHUNG
Suffix:
Gender:M
Credentials:MSOT, OTR/ L
Other - Prefix:MR
Other - First Name:NICHOLAS
Other - Middle Name:
Other - Last Name:CHUNG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSOT, OTR/ L
Mailing Address - Street 1:5106 RED RIVER DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76017-2014
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5106 RED RIVER DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76017-2014
Practice Address - Country:US
Practice Address - Phone:408-887-5871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-29
Last Update Date:2020-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20582225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist