Provider Demographics
NPI:1649988551
Name:CHANG, DAE-YONG PIETER (RRT)
Entity type:Individual
Prefix:
First Name:DAE-YONG
Middle Name:PIETER
Last Name:CHANG
Suffix:
Gender:M
Credentials:RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 CALEB WAY
Mailing Address - Street 2:
Mailing Address - City:BYRON
Mailing Address - State:GA
Mailing Address - Zip Code:31008-3850
Mailing Address - Country:US
Mailing Address - Phone:478-213-7996
Mailing Address - Fax:
Practice Address - Street 1:210 CALEB WAY
Practice Address - Street 2:
Practice Address - City:BYRON
Practice Address - State:GA
Practice Address - Zip Code:31008-3850
Practice Address - Country:US
Practice Address - Phone:478-213-7996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-09
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA9226227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered