Provider Demographics
NPI:1356414965
Name:BUENA PARK REHAB & PHYSICAL THERAPY, INC
Entity type:Organization
Organization Name:BUENA PARK REHAB & PHYSICAL THERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTIAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:CHUNG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:714-228-1114
Mailing Address - Street 1:7212 ORANGETHORPE AVE
Mailing Address - Street 2:SUITE #4
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90621-3341
Mailing Address - Country:US
Mailing Address - Phone:714-228-1114
Mailing Address - Fax:714-523-4970
Practice Address - Street 1:7212 ORANGETHORPE AVE
Practice Address - Street 2:SUITE #4
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90621-3341
Practice Address - Country:US
Practice Address - Phone:714-228-1114
Practice Address - Fax:714-523-4970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty