Healthcare Provider Details

I. General information

NPI: 1497954879
Provider Name (Legal Business Name): PHILIP CHI-LUEN CHANG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2007
Last Update Date: 05/06/2024
Certification Date: 05/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10301 HAGEN RANCH RD BLDG. A, STE 760
BOYNTON BEACH FL
33437-3724
US

IV. Provider business mailing address

900 S PINE ISLAND RD SUITE 800
PLANTATION FL
33324-3920
US

V. Phone/Fax

Practice location:
  • Phone: 561-733-4400
  • Fax: 561-733-5004
Mailing address:
  • Phone: 561-733-4400
  • Fax: 561-733-5004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME99379
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: