Provider Demographics
NPI:1215021217
Name:CHANG, DILLON YOUNG (MPT)
Entity Type:Individual
Prefix:MR
First Name:DILLON
Middle Name:YOUNG
Last Name:CHANG
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 W BEVERLY BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-2379
Mailing Address - Country:US
Mailing Address - Phone:323-725-0711
Mailing Address - Fax:323-725-0284
Practice Address - Street 1:2300 W BEVERLY BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-2379
Practice Address - Country:US
Practice Address - Phone:323-725-0711
Practice Address - Fax:323-725-0284
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT29155225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist