Provider Demographics
NPI:1962089342
Name:OH, CHUNG
Entity type:Individual
Prefix:
First Name:CHUNG
Middle Name:
Last Name:OH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:CHUNG MIN
Other - Middle Name:
Other - Last Name:OH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:13682 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-2630
Mailing Address - Country:US
Mailing Address - Phone:808-253-1221
Mailing Address - Fax:
Practice Address - Street 1:441 OLD NEWPORT BLVD
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-4233
Practice Address - Country:US
Practice Address - Phone:949-491-9991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-24
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA299942225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist