Provider Demographics
NPI:1023837887
Name:CHUNG, PETER INSEOK (PT, DPT, CSCS)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:INSEOK
Last Name:CHUNG
Suffix:
Gender:M
Credentials:PT, DPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4550 NORTHERN MOON WAY
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92154-4852
Mailing Address - Country:US
Mailing Address - Phone:602-577-8996
Mailing Address - Fax:
Practice Address - Street 1:600 PALM AVE STE 126
Practice Address - Street 2:
Practice Address - City:IMPERIAL BEACH
Practice Address - State:CA
Practice Address - Zip Code:91932-1246
Practice Address - Country:US
Practice Address - Phone:619-482-3000
Practice Address - Fax:619-332-4220
Is Sole Proprietor?:No
Enumeration Date:2024-10-08
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA306371225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist