Provider Demographics
NPI:1831105634
Name:CHANG-YU J HSIEH
Entity Type:Organization
Organization Name:CHANG-YU J HSIEH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHANG-YU
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:HSIEH
Authorized Official - Suffix:
Authorized Official - Credentials:MS, PT, DC, CA
Authorized Official - Phone:626-300-8341
Mailing Address - Street 1:320 SOUTH GARFIELD AVENUE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-6816
Mailing Address - Country:US
Mailing Address - Phone:626-300-8341
Mailing Address - Fax:626-300-8767
Practice Address - Street 1:320 SOUTH GARFIELD AVENUE
Practice Address - Street 2:SUITE 302
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-6816
Practice Address - Country:US
Practice Address - Phone:626-300-8341
Practice Address - Fax:626-300-8767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC19159111N00000X
CAPT10210225100000X
CAOT2625225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW14701AMedicare ID - Type UnspecifiedPHYSICAL THERAPY GROUP
CAW14701BMedicare ID - Type UnspecifiedCHIROPRACTIC GROUP
CAW14701Medicare ID - Type UnspecifiedPHYSICAL THERAPY GROUP