Healthcare Provider Details

I. General information

NPI: 1356414965
Provider Name (Legal Business Name): BUENA PARK REHAB & PHYSICAL THERAPY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7212 ORANGETHORPE AVE SUITE #4
BUENA PARK CA
90621-3341
US

IV. Provider business mailing address

7212 ORANGETHORPE AVE SUITE #4
BUENA PARK CA
90621-3341
US

V. Phone/Fax

Practice location:
  • Phone: 714-228-1114
  • Fax: 714-523-4970
Mailing address:
  • Phone: 714-228-1114
  • Fax: 714-523-4970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. CHRISTIAN E. CHUNG
Title or Position: VICE PRESIDENT
Credential: D.C.
Phone: 714-228-1114