Healthcare Provider Details

I. General information

NPI: 1003926189
Provider Name (Legal Business Name): PETER H CHANG DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 09/11/2024
Certification Date: 09/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 N GRAHAM ST STE 250
PORTLAND OR
97227-1666
US

IV. Provider business mailing address

PO BOX 821350
VANCOUVER WA
98682-0030
US

V. Phone/Fax

Practice location:
  • Phone: 503-280-3418
  • Fax: 503-284-7885
Mailing address:
  • Phone: 360-687-5221
  • Fax: 360-666-0466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License NumberOP00002095
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License NumberDO26736
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: