Provider Demographics
NPI:1447463369
Name:YIN, ALICE CHANG (MSPT)
Entity type:Individual
Prefix:
First Name:ALICE
Middle Name:CHANG
Last Name:YIN
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5449 CASTLE MANOR DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95129-4166
Mailing Address - Country:US
Mailing Address - Phone:408-446-2134
Mailing Address - Fax:
Practice Address - Street 1:1601 PETERSEN AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95129-4844
Practice Address - Country:US
Practice Address - Phone:408-253-7502
Practice Address - Fax:408-973-9776
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT18329225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist