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General NPI Number Information
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NPI Number | 1396460531
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Entity Type | Organization
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Legal Business Name | DOCTOR GWENDOLYN YEE CHANG OPTOMETRY, A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 10/10/2022
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Last Update Date | 06/20/2023
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Provider Practice Location Address
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Address Line | 1925 W TEMPLE ST
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City | LOS ANGELES
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State | CA
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Zip | 90026-4970
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Country | US
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Telephone | 213-277-1154
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Fax |
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Provider Business Mailing Address
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Address Line | 16388 COLIMA RD STE 101
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City | HACIENDA HEIGHTS
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State | CA
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Zip | 91745-5523
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Country | US
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Telephone | 626-854-1131
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. GWENDOLYN CHANG
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Credential | OD
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Telephone | 626-632-8034
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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