Provider Demographics
NPI:1780974543
Name:CHANG, YOUNG JIN (DPT)
Entity type:Individual
Prefix:DR
First Name:YOUNG JIN
Middle Name:
Last Name:CHANG
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 1:315 5TH AVE RM 1001
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-6587
Mailing Address - Country:US
Mailing Address - Phone:212-685-1004
Mailing Address - Fax:212-685-1007
Practice Address - Street 1:315 5TH AVE RM 1001
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6510
Practice Address - Country:US
Practice Address - Phone:212-685-1004
Practice Address - Fax:212-685-1007
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-13
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007157225200000X
NY032265225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant