Provider Demographics
NPI:1245507011
Name:CHANG, YING WEI JASON (PT)
Entity type:Individual
Prefix:DR
First Name:YING WEI
Middle Name:JASON
Last Name:CHANG
Suffix:
Gender:M
Credentials:PT
Other - Prefix:DR
Other - First Name:JASON
Other - Middle Name:
Other - Last Name:CHANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:1133 WAIMANU ST APT 1610
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-4256
Mailing Address - Country:US
Mailing Address - Phone:925-408-2860
Mailing Address - Fax:
Practice Address - Street 1:1133 WAIMANU ST APT 1610
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-4256
Practice Address - Country:US
Practice Address - Phone:925-408-2860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-22
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38433225100000X
HI3594225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFZ348ZMedicare UPIN