Healthcare Provider Details

I. General information

NPI: 1285152173
Provider Name (Legal Business Name): CYDNI CHANG DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CYDNI MATSUOKA

II. Dates (important events)

Enumeration Date: 08/31/2017
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

846 W FOOTHILL BLVD STE C
UPLAND CA
91786-3784
US

IV. Provider business mailing address

846 W FOOTHILL BLVD STE C
UPLAND CA
91786-3784
US

V. Phone/Fax

Practice location:
  • Phone: 909-985-8686
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number293617
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number043656
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: