Johnny Chang, DPT, L.AC.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

033956 Issued in NY

Practice address

7412 88TH St
Glendale, NY 11385-7952

Phone

(646) 493-9386

NPI assigned

Nov 11, 2011

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Dyevo Physical Therapy, P.C.

  • Physical Therapy Clinic/Center
  • Glendale, NY
  • NPI 1538506175
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1320969600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1453420800000",
    "number": "1699052159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5 MICHAELS LN",
            "city": "GLEN HEAD",
            "state": "NY",
            "postal_code": "115452014",
            "telephone_number": "516-424-3317"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7412 88TH ST",
            "city": "GLENDALE",
            "state": "NY",
            "postal_code": "113857952",
            "telephone_number": "646-493-9386"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHANG",
        "first_name": "JOHNNY",
        "name_prefix": "Dr.",
        "credential": "DPT, L.AC.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-11-11",
        "last_updated": "2016-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "033956",
            "primary": true
        },
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": "NY",
            "license": "005315",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Central Queens Day Surgical Center, Inc.
• Central Queens Day Surgical Center, Inc.
• Jason Chamikles, D.O.
• Julia Chan, O.D.
• Siu Mei Chan, OTR/L
• Alexis Chernoff, BCBA, LBA
• Jackie Rose Chessen, LMSW
• Child Care Pediatrics, P.C.
• Kevin Chin
• Francesco Chiodi

• All providers in Glendale, NY
• Physical Therapist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.