Healthcare Provider Details

I. General information

NPI: 1487904405
Provider Name (Legal Business Name): PAUL CHANG KIM PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2012
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15156 CANON LN
CHINO HILLS CA
91709-5215
US

IV. Provider business mailing address

15156 CANON LN
CHINO HILLS CA
91709-5215
US

V. Phone/Fax

Practice location:
  • Phone: 909-641-3379
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number39452
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: