Healthcare Provider Details

I. General information

NPI: 1962290023
Provider Name (Legal Business Name): LYAN CHANG SEDANO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2025
Last Update Date: 10/02/2025
Certification Date: 10/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 N. BROAD ST. TEMPLE UNIVERSITY HOSPITAL SUITE 810
PHILADELPHIA PA
19140
US

IV. Provider business mailing address

3401 N. BROAD ST. TEMPLE UNIVERSITY HOSPITAL SUITE 810
PHILADELPHIA PA
19140
US

V. Phone/Fax

Practice location:
  • Phone: 215-707-4085
  • Fax: 215-707-5978
Mailing address:
  • Phone: 215-707-4085
  • Fax: 215-707-5978

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMT234785
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: