MEDICARE: DR. DONGCHANG YANG DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT28713	CA
2	261QP2000X	Physical Therapy Clinic/Center	PT28713	CA

General Provider Information

NPI Number	:	1174567093
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DONGCHANG YANG DPT

Provider Business Mailing Address
First Line	:	1228 S. SAN GABRIEL BLVD
Second Line	:	STE. B
City	:	SAN GABRIEL
State	:	CA
Zip	:	91776-3170
Country	:	US
Telephone Number	:	626-291-5025
Fax Number	:	626-291-5055

Provider Business Practice Location Address
First Line	:	1228 S. SAN GABRIEL BLVD
Second Line	:	STE. B
City	:	SAN GABRIEL
State	:	CA
Zip	:	91776-3170
Country	:	US
Telephone Number	:	626-291-5025
Fax Number	:	626-291-5055

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2006
Last Update Date	:	05/26/2009

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