Healthcare Provider Details

I. General information

NPI: 1003487794
Provider Name (Legal Business Name): CHARLES WANG PHYSICAL THERAPIST PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2021
Last Update Date: 07/05/2021
Certification Date: 07/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

176 TERRAPIN
IRVINE CA
92618-0854
US

IV. Provider business mailing address

176 TERRAPIN
IRVINE CA
92618-0854
US

V. Phone/Fax

Practice location:
  • Phone: 714-878-3651
  • Fax:
Mailing address:
  • Phone: 714-878-3651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. CHARLES Y WANG
Title or Position: PHYSICAL THERAPIST, CEO, OWNER
Credential: PT, DPT
Phone: 714-878-3651