Healthcare Provider Details

I. General information

NPI: 1932490034
Provider Name (Legal Business Name): YONGEN CHANG MD, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2011
Last Update Date: 09/27/2024
Certification Date: 09/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 THE CITY DR S SUITE 400
ORANGE CA
92868-3201
US

IV. Provider business mailing address

101 THE CITY DR S SUITE 400
ORANGE CA
92868-3201
US

V. Phone/Fax

Practice location:
  • Phone: 714-456-7004
  • Fax:
Mailing address:
  • Phone: 714-456-7004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA115410
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA115410
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberA115410
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: