Healthcare Provider Details

I. General information

NPI: 1659514917
Provider Name (Legal Business Name): YOUNG DOO CHANG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2009
Last Update Date: 04/09/2024
Certification Date: 04/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12902 USF MAGNOLIA DR.
TAMPA FL
33612
US

IV. Provider business mailing address

12902 USF MAGNOLIA DR.
TAMPA FL
33612
US

V. Phone/Fax

Practice location:
  • Phone: 813-745-6853
  • Fax:
Mailing address:
  • Phone: 813-745-6853
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License NumberME122424
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: