Dae-Eil Chong
Individual provider Active NPI Physical Therapist · Tamuning, GU
NPI 1831474410 · NPPES record last updated Apr 25, 2023
Key facts
- NPI
- 1831474410
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- PT-156 (GU)
- Practice address
- 388 Ypao Rd
Tamuning, GU 96913-3701 - Phone
- (671) 646-8881
- Fax
- (671) 646-1292
- NPI assigned
- Oct 14, 2011
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT-156 | GU | MD | Physical Therapist |
| 033363 | NY | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sierra Physical Therapy Inc | Physical Therapist | Current |
Accepting new patients |
Locations
1110 Civic Center Blvd
Ste 502
Yuba City, CA 95993
Phone (530) 671-7770
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 38707 | CA | |
| Physical Therapist | 225100000X | 033363 | NY | |
| Physical Therapist | 225100000X | PT-156 | GU | Yes |
Addresses
Primary practice location
388 Ypao Rd
Tamuning, GU 96913-3701
Mailing address
20601 W Paoli Lane
Weimar, CA 95736
Other practice location 1
1110 Civic Center Blvd Ste 502
Yuba City, CA 95993-3015
Phone (530) 671-7977
Other providers in Tamuning, GU
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 25, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.