Healthcare Provider Details

I. General information

NPI: 1689810087
Provider Name (Legal Business Name): SOCAL PHYSICAL THERAPY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2009
Last Update Date: 12/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27616 NEWHALL RANCH RD SUITE 35
VALENCIA CA
91355-3482
US

IV. Provider business mailing address

26114 SALINGER LN
STEVENSON RANCH CA
91381-1107
US

V. Phone/Fax

Practice location:
  • Phone: 661-254-0488
  • Fax: 661-254-0490
Mailing address:
  • Phone: 661-254-0488
  • Fax: 661-254-0490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT28833
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC11597
License Number StateCA

VIII. Authorized Official

Name: DONGWON YOSUP JAHNG
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: D.P.T., L.A.C
Phone: 661-254-0488