Healthcare Provider Details

I. General information

NPI: 1174143622
Provider Name (Legal Business Name): REX DER CHANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2020
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2110 E EL SEGUNDO BLVD
EL SEGUNDO CA
90245-4548
US

IV. Provider business mailing address

2110 E EL SEGUNDO BLVD STE 200
EL SEGUNDO CA
90245-2743
US

V. Phone/Fax

Practice location:
  • Phone: 310-517-7010
  • Fax:
Mailing address:
  • Phone: 310-517-7030
  • Fax: 310-893-0428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA193710
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: