Healthcare Provider Details

I. General information

NPI: 1376299776
Provider Name (Legal Business Name): BRIAN HAE SEUNG CHANG PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2022
Last Update Date: 11/21/2022
Certification Date: 11/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

239 E KATELLA AVE
ORANGE CA
92867-4853
US

IV. Provider business mailing address

3230 E IMPERIAL HWY SUITE 100
BREA CA
92821-6735
US

V. Phone/Fax

Practice location:
  • Phone: 714-538-0025
  • Fax: 714-538-3128
Mailing address:
  • Phone: 714-988-8110
  • Fax: 714-988-8111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number301770
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT301770
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: