Basic Information
| Provider Information | |||||||||
| NPI: | 1437765468 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHANG | ||||||||
| FirstName: | QING | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1905 N PALM WAY | ||||||||
| Address2: | |||||||||
| City: | UPLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917841614 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9097583255 | ||||||||
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| Practice Location | |||||||||
| Address1: | 800 E 5TH ST | ||||||||
| Address2: | |||||||||
| City: | ONTARIO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917642432 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9099848629 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/16/2020 | ||||||||
| LastUpdateDate: | 09/16/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/16/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT38788 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.