Sang Kwak Physical Therapy, Inc.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT30257 Issued in CA

Legal business name

SANG KWAK PHYSICAL THERAPY, INC.

Practice address

12665 Garden Grove Blvd
Suite 707
Garden Grove, CA 92843-1921

Phone

(714) 537-1234

Fax

(714) 537-3256

NPI assigned

Aug 25, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Sang Chae Kwak, P.T.NPI 1538166525

Title

President

Phone

(714) 537-1234

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Sang Chae Kwak, P.T.

  • Physical Therapist
  • Garden Grove, CA
  • NPI 1538166525
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156464000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1417737600000",
    "number": "1003924697",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12665 GARDEN GROVE BLVD",
            "address_2": "SUITE 707",
            "city": "GARDEN GROVE",
            "state": "CA",
            "postal_code": "928431921",
            "telephone_number": "714-537-1234",
            "fax_number": "714-537-3256"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12665 GARDEN GROVE BLVD",
            "address_2": "SUITE 707",
            "city": "GARDEN GROVE",
            "state": "CA",
            "postal_code": "928431921",
            "telephone_number": "714-537-1234",
            "fax_number": "714-537-3256"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SANG KWAK PHYSICAL THERAPY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-25",
        "last_updated": "2014-12-05",
        "status": "A",
        "authorized_official_last_name": "KWAK",
        "authorized_official_first_name": "SANG CHAE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "714-537-1234",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "P.T."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT30257",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3332040",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Elyse Aiko Sandoval -Konishi
• Anthony Gabriel Sandoval
• Laura Sandoval
• Walter Sandoval
• Sang H. Park Dental Corp
• Sang Lee & Deuk Oh DDS Inc
• Sang Lee & Deuk Oh, DDS, Inc
• Sanghoon Park, DDS, Inc.
• Megha Sanghu
• Abigail Sangren

• Physical Therapist in Garden Grove, CA
• Providers in Garden Grove, CA by specialty
• Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.