Healthcare Provider Details

I. General information

NPI: 1215192901
Provider Name (Legal Business Name): YOUNG PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2008
Last Update Date: 07/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42301 10TH ST W
LANCASTER CA
93534-7000
US

IV. Provider business mailing address

PO BOX 5203
LANCASTER CA
93539
US

V. Phone/Fax

Practice location:
  • Phone: 661-942-2202
  • Fax: 661-942-2203
Mailing address:
  • Phone: 661-942-2202
  • Fax: 661-942-2203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number27406
License Number StateCA

VIII. Authorized Official

Name: DR. YOUNGHOON KIM
Title or Position: PRESIDENT
Credential: PHYSICAL THERAPIST
Phone: 661-942-2202