=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609441070
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHANG MEDICAL, A PROFESSIONAL CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/26/2021
-----------------------------------------------------
Last Update Date | 05/26/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 500 N GARFIELD AVE STE 204
-----------------------------------------------------
City | MONTEREY PARK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91754-1242
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-280-4393
-----------------------------------------------------
Fax | 626-280-5379
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 500 N GARFIELD AVE STE 204
-----------------------------------------------------
City | MONTEREY PARK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91754-1242
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-280-4393
-----------------------------------------------------
Fax | 626-280-5379
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | WILLIAM YOW-JUNG CHANG
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 626-280-4393
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RP1001X
-----------------------------------------------------
Taxonomy Name | Pulmonary Disease Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------