Provider Demographics
NPI:1962732230
Name:CHUNG, MAN SUM (PHD, LBA, BCBA-D)
Entity type:Individual
Prefix:
First Name:MAN SUM
Middle Name:
Last Name:CHUNG
Suffix:
Gender:F
Credentials:PHD, LBA, BCBA-D
Other - Prefix:
Other - First Name:IVY MAN SUM
Other - Middle Name:
Other - Last Name:CHUNG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD, LBA, BCBA-D
Mailing Address - Street 1:2310 130TH AVE. NE SUITE 202
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005
Mailing Address - Country:US
Mailing Address - Phone:425-882-8868
Mailing Address - Fax:425-633-2282
Practice Address - Street 1:2310 130TH AVE. NE SUITE 100
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005
Practice Address - Country:US
Practice Address - Phone:425-882-8868
Practice Address - Fax:425-633-2282
Is Sole Proprietor?:No
Enumeration Date:2010-01-08
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1-08-4846103K00000X
WALBABA60765071103K00000X
1-08-4846103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst