Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist |
NPI | 1427247865 |
---|---|
Provider Name | Robert Chung |
First Address | Torrance, CA 90505-4760 |
Second Address | Torrance, CA 90505-4760 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/10/2007 |
Last Update Date | 22/10/2007 |