Healthcare Provider Details

I. General information

NPI: 1245223619
Provider Name (Legal Business Name): WILLIAM WEI-JUNG CHANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: WEI-JUNG WILLIAM CHANG MD

II. Dates (important events)

Enumeration Date: 08/31/2005
Last Update Date: 02/19/2021
Certification Date: 02/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

770 W HIGH ST STE 160
LIMA OH
45801-5900
US

IV. Provider business mailing address

770 W HIGH ST STE 160
LIMA OH
45801-5900
US

V. Phone/Fax

Practice location:
  • Phone: 419-996-5224
  • Fax: 419-996-5276
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberK5079
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number188561
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number188561
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number35-092684
License Number StateOH

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier3013198
Identifier TypeMEDICAID
Identifier StateOH
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: