=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285620468
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RICHARD Y CHANG MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/23/2005
-----------------------------------------------------
Last Update Date | 12/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 960 CLAGUE RD STE 1200 SEIDMAN CANCER CENTER
-----------------------------------------------------
City | WESTLAKE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44145-1585
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-250-2812
-----------------------------------------------------
Fax | 440-250-2821
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 24701 EUCLID AVE THIRD FLOOR
-----------------------------------------------------
City | EUCLID
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44117-1714
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-250-2812
-----------------------------------------------------
Fax | 440-250-2821
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RH0003X
-----------------------------------------------------
Taxonomy Name | Hematology & Oncology Physician
-----------------------------------------------------
License Number | 223917
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RH0003X
-----------------------------------------------------
Taxonomy Name | Hematology & Oncology Physician
-----------------------------------------------------
License Number | 35-098177
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------