Provider Demographics
NPI:1487736674
Name:KANG PHYSICAL THERAPY
Entity type:Organization
Organization Name:KANG PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:CHANG YUN
Authorized Official - Last Name:KANG
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:805-205-3667
Mailing Address - Street 1:2112 EASTMAN AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-5773
Mailing Address - Country:US
Mailing Address - Phone:805-658-8300
Mailing Address - Fax:805-658-8318
Practice Address - Street 1:2112 EASTMAN AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-5773
Practice Address - Country:US
Practice Address - Phone:805-658-8300
Practice Address - Fax:805-658-8318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT280812251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT28081OtherLICENSE
CAPT28451OtherLICENSE
WPT28451EMedicare ID - Type Unspecified
CAW19582Medicare ID - Type Unspecified
WPT28081DMedicare ID - Type Unspecified
CAPT28451OtherLICENSE
CAQ47368Medicare UPIN