Healthcare Provider Details

I. General information

NPI: 1649844085
Provider Name (Legal Business Name): OLIVIA WEI CHANG PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2021
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 OLD NEWPORT BLVD STE 201
NEWPORT BEACH CA
92663-4289
US

IV. Provider business mailing address

401 OLD NEWPORT BLVD STE 201
NEWPORT BEACH CA
92663-4289
US

V. Phone/Fax

Practice location:
  • Phone: 949-478-7373
  • Fax:
Mailing address:
  • Phone: 949-478-7373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA63012
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: