Healthcare Provider Details

I. General information

NPI: 1174567093
Provider Name (Legal Business Name): DONGCHANG YANG DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 05/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1228 S. SAN GABRIEL BLVD STE. B
SAN GABRIEL CA
91776-3170
US

IV. Provider business mailing address

1228 S. SAN GABRIEL BLVD STE. B
SAN GABRIEL CA
91776-3170
US

V. Phone/Fax

Practice location:
  • Phone: 626-291-5025
  • Fax: 626-291-5055
Mailing address:
  • Phone: 626-291-5025
  • Fax: 626-291-5055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT28713
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT28713
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: