Healthcare Provider Details

I. General information

NPI: 1164339479
Provider Name (Legal Business Name): SEONGYEOP CHIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31852 COAST HWY #303
LAGUNA BEACH CA
92651
US

IV. Provider business mailing address

6561 BEACH BLVD
BUENA PARK CA
90621
US

V. Phone/Fax

Practice location:
  • Phone: 949-499-9559
  • Fax:
Mailing address:
  • Phone: 949-468-8686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number55071
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: