Healthcare Provider Details

I. General information

NPI: 1508004193
Provider Name (Legal Business Name): WEN-SHI CHANG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2009
Last Update Date: 05/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 S CHEVY CHASE DR #250
GLENDALE CA
91205-4431
US

IV. Provider business mailing address

801 S CHEVY CHASE DR #20
GLENDALE CA
91205-4431
US

V. Phone/Fax

Practice location:
  • Phone: 818-265-2264
  • Fax: 818-265-2263
Mailing address:
  • Phone: 323-454-4485
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA118395
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: