NPIMap

Organization Active NPI

Socal Physical Therapy Inc.

  • Physical Therapy Clinic/Center
  • Valencia, CA
National Provider Identifier
1689810087
Registry record updated Dec 16, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
License
PT28833 Issued in CA
Legal business name
SOCAL PHYSICAL THERAPY INC.
Practice address
27616 Newhall Ranch Rd
Suite 35
Valencia, CA 91355-3482
Phone
(661) 254-0488
Fax
(661) 254-0490
NPI assigned
Jan 6, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 16, 2011

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

Authorized official

Name
Dongwon Yosup Jahng, D.P.T., L.A.CNPI 1568504207
Title
Chief Executive Officer
Phone
(661) 254-0488

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
AcupuncturistGroup: 193200000X MULTI-SPECIALTY GROUP 171100000X AC11597 CA
Physical Therapy Clinic/Center 261QP2000X PT28833 CA Primary

Addresses

Primary practice location

27616 Newhall Ranch Rd
Suite 35
Valencia, CA 91355-3482

Mailing address

26114 Salinger LN
Stevenson Ranch, CA 91381-1107
Phone (661) 254-0488

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090507000192 CA Part B Supplier - Clinic/Group Practice 3779631445 Receives reassigned benefits from 4 practitioners
Practice locations: Valencia, CA

National Provider Directory

National Provider Directory

Locations

27616 Newhall Ranch Rd
Unit 35
Valencia, CA 91355
Phone (661) 254-0488

27616 Newhall Ranch Rd
Ste A35
Valencia, CA 91355

Practitioners & affiliated clinicians

Practitioners 5

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

NPI Registry JSON

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

{
    "created_epoch": "1231200000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1323993600000",
    "number": "1689810087",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26114 SALINGER LN",
            "city": "STEVENSON RANCH",
            "state": "CA",
            "postal_code": "913811107",
            "telephone_number": "661-254-0488",
            "fax_number": "661-254-0490"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "27616 NEWHALL RANCH RD",
            "address_2": "SUITE 35",
            "city": "VALENCIA",
            "state": "CA",
            "postal_code": "913553482",
            "telephone_number": "661-254-0488",
            "fax_number": "661-254-0490"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOCAL PHYSICAL THERAPY INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-01-06",
        "last_updated": "2011-12-16",
        "status": "A",
        "authorized_official_last_name": "JAHNG",
        "authorized_official_first_name": "DONGWON",
        "authorized_official_middle_name": "YOSUP",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "661-254-0488",
        "authorized_official_credential": "D.P.T., L.A.C"
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Acupuncturist",
            "state": "CA",
            "license": "AC11597",
            "primary": false
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "CA",
            "license": "PT28833",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Valencia, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2011; 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.