Healthcare Provider Details

I. General information

NPI: 1285994699
Provider Name (Legal Business Name): WILSON JOON CHANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2012
Last Update Date: 05/02/2025
Certification Date: 05/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 8TH AVE NE STE 200
ISSAQUAH WA
98029-5436
US

IV. Provider business mailing address

510 8TH AVE NE STE 320
ISSAQUAH WA
98029-5436
US

V. Phone/Fax

Practice location:
  • Phone: 425-392-3030
  • Fax: 425-392-2564
Mailing address:
  • Phone: 425-392-3030
  • Fax: 425-392-2564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberMD60776326
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberMD60776326
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: