Provider Demographics
NPI:1992767883
Name:CHANG, VICTOR (PT)
Entity type:Individual
Prefix:MR
First Name:VICTOR
Middle Name:
Last Name:CHANG
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4980 BARRANCA PKWAY
Mailing Address - Street 2:201
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-8652
Mailing Address - Country:US
Mailing Address - Phone:949-727-0770
Mailing Address - Fax:949-727-7432
Practice Address - Street 1:4980 BARRANCA PKWAY
Practice Address - Street 2:201
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-8652
Practice Address - Country:US
Practice Address - Phone:949-727-0770
Practice Address - Fax:949-727-7432
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-05
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA29183225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WPT29183AMedicare PIN
Q57487Medicare UPIN