Healthcare Provider Details

I. General information

NPI: 1417690041
Provider Name (Legal Business Name): ANDREW YEHUY CHANG DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2022
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30281 GOLDEN LANTERN
LAGUNA NIGUEL CA
92677-5979
US

IV. Provider business mailing address

2355 WESTWOOD BLVD # 1265
LOS ANGELES CA
90064-2109
US

V. Phone/Fax

Practice location:
  • Phone: 949-495-7144
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number8114
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A23528
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: