Healthcare Provider Details

I. General information

NPI: 1164008272
Provider Name (Legal Business Name): WON JIN CHANG DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2021
Last Update Date: 12/06/2021
Certification Date: 03/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 S BUENA VISTA ST
BURBANK CA
91505-4809
US

IV. Provider business mailing address

2303 JEFFERSON ST UNIT 1204
TORRANCE CA
90501-3396
US

V. Phone/Fax

Practice location:
  • Phone: 818-847-4405
  • Fax:
Mailing address:
  • Phone: 310-710-4900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251C2600X
TaxonomyCardiopulmonary Physical Therapist
License Number298472
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number298472
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number298472
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number298472
License Number StateCA
# 5
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number298472
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: