Bong Su Jang, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT296936 Issued in CA

Practice address

415 E Avenida Pico Ste M
San Clemente, CA 92672-3800

Phone

(949) 245-6581

NPI assigned

Jan 22, 2020

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

California Luna Care Physical Therapy PCGroup PAC ID 9638427834, 769 clinicians

Fairbanks and Power Physical Therapy CorpGroup PAC ID 6406843481, 53 clinicians

California Rehabilitation and Sports Therapy a California Physical theGroup PAC ID 6709788896, 182 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• California Luna Care Physical Therapy PC

  • Physical Therapist
  • Los Gatos, CA
  • NPI 1689162166
  Medicare reassignment Care Compare group NPD
• California Rehabilitation & Sports Therapy a California Physical Ther

  dba California Rehabilitation & Sports Therapy

  • Multi-Specialty Clinic/Center
  • Mission Viejo, CA
  • NPI 1386696409

  Physical Therapist

  Medicare reassignment Care Compare group NPD
• Fairbanks & Power Physical Therapy Corp.

  dba PacificPro Physical Therapy & Sports Medicine

  • Physical Therapist
  • Irvine, CA
  • NPI 1912953936
  Medicare reassignment Care Compare group
• California Rehab & Sports Therapy

  • Multi-Specialty Clinic/Center
  • Los Angeles, CA
  • NPI 1508540279
  NPD
• California Rehabilitation & Sports Therapy a California Physical Ther

  dba California Rehabilitation & Sports Therapy

  • Physical Therapist
  • Irvine, CA
  • NPI 1568414597
  NPD

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

{
    "created_epoch": "1579651200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659916800000",
    "number": "1255961850",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "415 E AVENIDA PICO STE M",
            "city": "SAN CLEMENTE",
            "state": "CA",
            "postal_code": "926723800",
            "telephone_number": "949-245-6581"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "415 E AVENIDA PICO STE M",
            "city": "SAN CLEMENTE",
            "state": "CA",
            "postal_code": "926723800",
            "telephone_number": "949-245-6581"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JANG",
        "first_name": "BONG SU",
        "credential": "DPT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-01-22",
        "last_updated": "2022-08-08",
        "certification_date": "2022-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT296936",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jaesung Kim DMD Inc (I love my dentist)
• Carolyn Kay Jahan, MFT
• Colin Xephary Jairam, MD
• James E Keany, MD, Apmc
• James E Sorge DMD a Professional Corporation (Epic Family Dental)
• Barbara Y Jaramillo
• Michael Jaramillo, D.C.
• McKenna Jarrell
• Jean M Lim Optometry, Inc (seaside eyecare)
• Carolyn Jeffers

• Physical Therapist in San Clemente, CA
• Providers in San Clemente, CA by specialty
• Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.