Provider Demographics
NPI:1568504207
Name:JAHNG, DONGWON (DPT)
Entity Type:Individual
Prefix:DR
First Name:DONGWON
Middle Name:
Last Name:JAHNG
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26114 SALINGER LN
Mailing Address - Street 2:
Mailing Address - City:STEVENSON RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:91381-1107
Mailing Address - Country:US
Mailing Address - Phone:310-474-5729
Mailing Address - Fax:
Practice Address - Street 1:27616 NEWHALL RANCH RD
Practice Address - Street 2:SUITE 35
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-3482
Practice Address - Country:US
Practice Address - Phone:661-254-0488
Practice Address - Fax:661-254-0490
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC11597171100000X
CAPT28833225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturist