Healthcare Provider Details

I. General information

NPI: 1730348269
Provider Name (Legal Business Name): MARISA CORINNE CHANG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2008
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2730 WILSHIRE BLVD STE 320
SANTA MONICA CA
90403
US

IV. Provider business mailing address

2730 WILSHIRE BLVD STE 320
SANTA MONICA CA
90403
US

V. Phone/Fax

Practice location:
  • Phone: 310-382-1150
  • Fax: 310-382-1153
Mailing address:
  • Phone: 310-382-1150
  • Fax: 310-382-1153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberA93323
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: