Healthcare Provider Details

I. General information

NPI: 1558990945
Provider Name (Legal Business Name): ALFREDO LEE CHANG MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2020
Last Update Date: 04/20/2020
Certification Date: 04/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 N GARFIELD AVE STE 204
MONTEREY PARK CA
91754-1242
US

IV. Provider business mailing address

500 N GARFIELD AVE STE 204
MONTEREY PARK CA
91754-1242
US

V. Phone/Fax

Practice location:
  • Phone: 626-280-4393
  • Fax: 626-280-5379
Mailing address:
  • Phone: 626-280-4393
  • Fax: 626-280-5379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: ALFREDO LEE CHANG
Title or Position: OWNER
Credential: MD
Phone: 626-280-4393