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NPI Code Detail

MEDICARE: SANG KWAK PHYSICAL THERAPY, INC.

MEDICARE: SANG KWAK PHYSICAL THERAPY, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical TherapistPT30257CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1003924697
Entity Type Code : Organization
Provider Name (Legal Business Name) : SANG KWAK PHYSICAL THERAPY, INC.
Provider Business Mailing Address
First Line : 12665 GARDEN GROVE BLVD
Second Line : SUITE 707
City : GARDEN GROVE
State : CA
Zip : 92843-1921
Country : US
Telephone Number : 714-537-1234
Fax Number : 714-537-3256
Provider Business Practice Location Address
First Line : 12665 GARDEN GROVE BLVD
Second Line : SUITE 707
City : GARDEN GROVE
State : CA
Zip : 92843-1921
Country : US
Telephone Number : 714-537-1234
Fax Number : 714-537-3256
Authorized Official
Title or Position : PRESIDENT
Name : MR. SANG CHAE KWAK
Credential : P.T.
Telephone Number : 714-537-1234
Provider Enumeration Date : 08/25/2006
Last Update Date : 12/05/2014

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