Healthcare Provider Details

I. General information

NPI: 1184624652
Provider Name (Legal Business Name): CHANG YONG CHI P.T., L.AC. RN.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2005
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3830 PARSONS BLVD STE 1B
FLUSHING NY
11354-5840
US

IV. Provider business mailing address

3830 PARSONS BLVD STE 1B
FLUSHING NY
11354-5841
US

V. Phone/Fax

Practice location:
  • Phone: 718-321-0205
  • Fax: 718-321-1442
Mailing address:
  • Phone: 718-321-0205
  • Fax: 718-321-1442

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number026153
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number347302
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberN15520
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number4395
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: