Healthcare Provider Details

I. General information

NPI: 1932738408
Provider Name (Legal Business Name): CHRIS H CHANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2020
Last Update Date: 10/12/2023
Certification Date: 10/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3255 WILSHIRE BLVD STE 120
LOS ANGELES CA
90010-1405
US

IV. Provider business mailing address

3727 W 6TH ST STE 210
LOS ANGELES CA
90020-5108
US

V. Phone/Fax

Practice location:
  • Phone: 213-235-2500
  • Fax:
Mailing address:
  • Phone: 213-235-2500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA177589
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: