Healthcare Provider Details

I. General information

NPI: 1659326460
Provider Name (Legal Business Name): WEILING CHANG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 03/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8881 FLETCHER PARKWAY #102
LA MESA CA
91942
US

IV. Provider business mailing address

7777 ALVARADO RD #108
LA MESA CA
91942
US

V. Phone/Fax

Practice location:
  • Phone: 619-461-1830
  • Fax: 619-797-1484
Mailing address:
  • Phone: 619-460-2770
  • Fax: 619-460-2774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA900535
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA90535
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: