Provider Demographics
NPI:1538253364
Name:KANG, DANIEL CHANG YUN (DPT)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:CHANG YUN
Last Name:KANG
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 1:319 N THE GREENS AVE
Mailing Address - Street 2:
Mailing Address - City:NEWBERG
Mailing Address - State:OR
Mailing Address - Zip Code:97132-7464
Mailing Address - Country:US
Mailing Address - Phone:503-487-6221
Mailing Address - Fax:503-683-8071
Practice Address - Street 1:319 N THE GREENS AVE
Practice Address - Street 2:
Practice Address - City:NEWBERG
Practice Address - State:OR
Practice Address - Zip Code:97132-7464
Practice Address - Country:US
Practice Address - Phone:503-487-6221
Practice Address - Fax:503-683-8071
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR062382251G0304X, 225100000X
ORPT 062382251C2600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatricsGroup - Single Specialty
No2251C2600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistCardiopulmonaryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP98141Medicare UPIN
CAW19582Medicare ID - Type Unspecified
CAQ47368Medicare UPIN