Healthcare Provider Details

I. General information

NPI: 1487736674
Provider Name (Legal Business Name): KANG PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 10/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2112 EASTMAN AVE SUITE 101
VENTURA CA
93003-5773
US

IV. Provider business mailing address

2112 EASTMAN AVE SUITE 101
VENTURA CA
93003-5773
US

V. Phone/Fax

Practice location:
  • Phone: 805-658-8300
  • Fax: 805-658-8318
Mailing address:
  • Phone: 805-658-8300
  • Fax: 805-658-8318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT28081
License Number StateCA

VIII. Authorized Official

Name: DANIEL CHANG YUN KANG
Title or Position: OWNER
Credential: DPT
Phone: 805-205-3667