Healthcare Provider Details

I. General information

NPI: 1003350984
Provider Name (Legal Business Name): PATRICIA YEE-LING CHANG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2016
Last Update Date: 07/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1131 WILSHIRE BLVD SUITE 300
SANTA MONICA CA
90401-2061
US

IV. Provider business mailing address

5767 W CENTURY BLVD SUITE 400
LOS ANGELES CA
90045-5631
US

V. Phone/Fax

Practice location:
  • Phone: 310-395-5588
  • Fax:
Mailing address:
  • Phone: 310-301-8707
  • Fax: 310-301-8751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC146039
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: