Healthcare Provider Details

I. General information

NPI: 1417339607
Provider Name (Legal Business Name): ELLEN CHANG WONG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELLEN CHANG MD

II. Dates (important events)

Enumeration Date: 06/24/2015
Last Update Date: 05/06/2022
Certification Date: 05/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7601 IMPERIAL HWY
DOWNEY CA
90242-3456
US

IV. Provider business mailing address

7601 IMPERIAL HWY TRLR F6
DOWNEY CA
90242-3456
US

V. Phone/Fax

Practice location:
  • Phone: 562-385-7111
  • Fax:
Mailing address:
  • Phone: 562-385-7111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberA146928
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: