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NPI Code Detail

MEDICARE: MR. SANG CHAE KWAK P.T.

MEDICARE: MR. SANG CHAE KWAK P.T.
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

General Provider Information

NPI Number : 1538166525
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. SANG CHAE KWAK P.T.
Provider Business Mailing Address
First Line : 12665 GARDEN GROVE BLVD
Second Line : SUITE 707
City : GARDEN GROVE
State : CA
Zip : 92843-1901
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 : 92843-1901
Country : US
Telephone Number : 714-537-1234
Fax Number : 714-537-3256
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/05/2005
Last Update Date : 08/12/2014

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