Provider Demographics
NPI:1689810087
Name:SOCAL PHYSICAL THERAPY INC.
Entity Type:Organization
Organization Name:SOCAL PHYSICAL THERAPY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DONGWON
Authorized Official - Middle Name:YOSUP
Authorized Official - Last Name:JAHNG
Authorized Official - Suffix:
Authorized Official - Credentials:DPT, LAC
Authorized Official - Phone:661-254-0488
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:661-254-0488
Mailing Address - Fax:661-254-0490
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-06
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC11597171100000X
CAPT28833261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty