MEDICARE: CHANG QU 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	309702	CA

General Provider Information

NPI Number	:	1316898208
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHANG QU DPT

Provider Business Mailing Address
First Line	:	3716 SUMMER LN
Second Line	:
City	:	BALDWIN PARK
State	:	CA
Zip	:	91706-3677
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	501 S VINCENT AVE
Second Line	:
City	:	WEST COVINA
State	:	CA
Zip	:	91790-6712
Country	:	US
Telephone Number	:	626-856-5588
Fax Number	:

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

Provider Enumeration Date	:	02/05/2026
Last Update Date	:	02/05/2026

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