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General NPI Number Information
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NPI Number | 1023539772
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Entity Type | Individual
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Provider Name | PAUL CHANG
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Gender | Male
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Dates
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Enumeration Date | 07/03/2017
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Last Update Date | 06/14/2023
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Provider Practice Location Address
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Address Line | LINCOLN ST BLDG 9900
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City | TACOMA
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State | WA
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Zip | 98431-0001
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Country | US
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Telephone | 917-355-6009
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Fax |
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Provider Business Mailing Address
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Address Line | 6109 62ND AVE W
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City | UNIVERSITY PLACE
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State | WA
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Zip | 98467-4902
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number | DE61292243
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License Number State | WA
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