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General NPI Number Information
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NPI Number | 1649305145
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Entity Type | Individual
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Provider Name | THEODORE E YANG DPT, OCS, CSCS
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Gender | Male
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Dates
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Enumeration Date | 02/23/2007
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Last Update Date | 12/03/2021
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Provider Practice Location Address
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Address Line | 6041 CADILLAC AVE
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City | LOS ANGELES
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State | CA
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Zip | 90034-1702
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Country | US
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Telephone | 323-857-2458
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Fax |
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Provider Business Mailing Address
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Address Line | 6041 CADILLAC AVE
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City | LOS ANGELES
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State | CA
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Zip | 90034-1702
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Country | US
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Telephone | 323-857-2458
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 17691
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 30447
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License Number State | CA
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