Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 298472 | CA |
N | 2251C2600X | Cardiopulmonary | 298472 | CA |
N | 2251G0304X | Physical Therapist - Geriatrics | 298472 | CA |
N | 2251N0400X | Physical Therapist - Neurology | 298472 | CA |
N | 2251X0800X | Physical Therapist - Orthopedic | 298472 | CA |
NPI | 1164008272 |
---|---|
Provider Name | Mr. Won Jin Chang |
First Address | Torrance, CA 90501-3396 |
Second Address | Burbank, CA 91505-4809 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2021 |
Last Update Date | 06/12/2021 |