Provider Demographics
NPI:1235892407
Name:CHANG, ALEXANDER GEORGE (DPT)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:GEORGE
Last Name:CHANG
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21906 PIONEER BLVD
Mailing Address - Street 2:
Mailing Address - City:HAWAIIAN GARDENS
Mailing Address - State:CA
Mailing Address - Zip Code:90716-1239
Mailing Address - Country:US
Mailing Address - Phone:626-298-5437
Mailing Address - Fax:562-431-4854
Practice Address - Street 1:5152 KATELLA AVE STE 106
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-2843
Practice Address - Country:US
Practice Address - Phone:562-431-6004
Practice Address - Fax:562-431-4854
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-14
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT301008225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist