Healthcare Provider Details

I. General information

NPI: 1508893736
Provider Name (Legal Business Name): PI-NIAN CHANG PHD, LP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIVERSITY OF MINNESOTA PHYSICIANS 516 DELAWARE STREET SE, PWB FOURTH FLOOR, ROOM 4-100
MINNEAPOLIS MN
55455
US

IV. Provider business mailing address

UNIVERSITY OF MINNESOTA PHYSICIANS MCNAMARA CENTER, 200 OAK STREET SE, ROOM 270
MINNEAPOLIS MN
55455
US

V. Phone/Fax

Practice location:
  • Phone: 612-672-7122
  • Fax:
Mailing address:
  • Phone: 612-626-2820
  • Fax: 612-624-0997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberLP2634
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: