Healthcare Provider Details

I. General information

NPI: 1902385891
Provider Name (Legal Business Name): ALEXANDER CHANG PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2018
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date: 04/10/2023
Reactivation Date: 09/05/2023

III. Provider practice location address

4744 41ST AVE SW STE 101
SEATTLE WA
98116-4566
US

IV. Provider business mailing address

PO BOX 25608
SALT LAKE CITY UT
84125-0608
US

V. Phone/Fax

Practice location:
  • Phone: 206-320-5780
  • Fax: 206-320-5794
Mailing address:
  • Phone: 206-320-4476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPY70063749
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY70063749
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: