Provider Demographics
NPI:1376299776
Name:CHANG, BRIAN HAE SEUNG (PT, DPT)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:HAE SEUNG
Last Name:CHANG
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3230 E IMPERIAL HWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-6735
Mailing Address - Country:US
Mailing Address - Phone:714-988-8110
Mailing Address - Fax:714-988-8111
Practice Address - Street 1:239 E KATELLA AVE
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92867-4853
Practice Address - Country:US
Practice Address - Phone:714-538-0025
Practice Address - Fax:714-538-3128
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-23
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA301770225100000X
CAPT301770225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist