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General NPI Number Information
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NPI Number | 1528195989
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Entity Type | Individual
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Provider Name | EVELYN T. CHANG MD
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Gender | Female
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Dates
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Enumeration Date | 02/27/2007
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Last Update Date | 05/24/2016
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Provider Practice Location Address
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Address Line | 11301 WILSHIRE BLVD DEPT OF GIM (111G)
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City | LOS ANGELES
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State | CA
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Zip | 90073-1003
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Country | US
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Telephone | 310-478-3711
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Fax |
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Provider Business Mailing Address
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Address Line | 821 BAY ST UNIT B2
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City | SANTA MONICA
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State | CA
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Zip | 90405-1343
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Country | US
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Telephone | 617-777-5472
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | L-228804
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License Number State | MA
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