Healthcare Provider Details

I. General information

NPI: 1053556035
Provider Name (Legal Business Name): CHING-WEN ANGELA CHANG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2008
Last Update Date: 02/04/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3570 S RIVER PKWY UNIT 1509
PORTLAND OR
97239-4534
US

IV. Provider business mailing address

3570 S RIVER PKWY UNIT 1509
PORTLAND OR
97239-4534
US

V. Phone/Fax

Practice location:
  • Phone: 917-608-1952
  • Fax:
Mailing address:
  • Phone: 917-608-1952
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License NumberMD28405
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: