Healthcare Provider Details

I. General information

NPI: 1295340792
Provider Name (Legal Business Name): NAUM PHYSICAL THERAPY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2020
Last Update Date: 09/10/2020
Certification Date: 09/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11405 FULBOURN CT
RANCHO CUCAMONGA CA
91730-8341
US

IV. Provider business mailing address

11405 FULBOURN CT
RANCHO CUCAMONGA CA
91730-8341
US

V. Phone/Fax

Practice location:
  • Phone: 571-835-5038
  • Fax:
Mailing address:
  • Phone: 571-835-5038
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: YONGHA KIM
Title or Position: PRESIDENT
Credential: PT
Phone: 571-835-5038