Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | PSY26045 | CA |
Y | 103T00000X | Psychologist | PSY26045 | CA |
N | 225C00000X | Rehabilitation Counselor |
NPI | 1093964876 |
---|---|
Provider Name | Betsy P Chung |
First Address | Newport Beach, CA 92660-3024 |
Second Address | Newport Beach, CA 92660-3024 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2008 |
Last Update Date | 12/12/2016 |