Provider Demographics
NPI:1184624652
Name:CHI, CHANG YONG (PT, LAC)
Entity type:Individual
Prefix:MR
First Name:CHANG
Middle Name:YONG
Last Name:CHI
Suffix:
Gender:M
Credentials:PT, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3830 PARSONS BLVD STE 1B
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-5840
Mailing Address - Country:US
Mailing Address - Phone:718-321-0205
Mailing Address - Fax:718-321-1442
Practice Address - Street 1:3830 PARSONS BLVD STE 1B
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-5840
Practice Address - Country:US
Practice Address - Phone:718-321-0205
Practice Address - Fax:718-321-1442
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-27
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY347302164W00000X
NY4395171100000X
NY026153225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No164W00000XNursing Service ProvidersLicensed Practical Nurse
No171100000XOther Service ProvidersAcupuncturist