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General NPI Number Information
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NPI Number | 1033733035
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Entity Type | Individual
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Provider Name | BRADFORD K.W. CHANG PHD
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Gender | Male
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Dates
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Enumeration Date | 06/04/2020
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Last Update Date | 06/04/2020
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Provider Practice Location Address
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Address Line | 13620 NE 20TH ST STE I
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City | BELLEVUE
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State | WA
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Zip | 98005-4901
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Country | US
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Telephone | 425-533-8173
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Fax |
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Provider Business Mailing Address
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Address Line | 6139 147TH PL SE
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City | BELLEVUE
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State | WA
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Zip | 98006-4601
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Country | US
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Telephone | 425-533-8173
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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 | 103TM1800X
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Taxonomy Name | Intellectual & Developmental Disabilities Psychologist
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License Number | PY00002048
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License Number State | WA
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