Provider Demographics
NPI:1487904405
Name:KIM, PAUL CHANG (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:CHANG
Last Name:KIM
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4021 ORANGE AVE
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:CA
Mailing Address - Zip Code:90630-2715
Mailing Address - Country:US
Mailing Address - Phone:800-707-5768
Mailing Address - Fax:888-723-3351
Practice Address - Street 1:4021 ORANGE AVE
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:CA
Practice Address - Zip Code:90630-2715
Practice Address - Country:US
Practice Address - Phone:800-707-5768
Practice Address - Fax:888-723-3351
Is Sole Proprietor?:No
Enumeration Date:2012-09-18
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39452225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist