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General NPI Number Information
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NPI Number | 1649752932
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Entity Type | Organization
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Legal Business Name | JOHN CHANG MD PC
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Dates
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Enumeration Date | 09/03/2018
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Last Update Date | 09/03/2018
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Provider Practice Location Address
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Address Line | 1625 W OLYMPIC BLVD STE M100
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City | LOS ANGELES
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State | CA
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Zip | 90015-3824
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Country | US
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Telephone | 310-766-5947
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Fax | 855-292-8588
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Provider Business Mailing Address
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Address Line | PO BOX 251615
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City | LOS ANGELES
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State | CA
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Zip | 90025-9243
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Country | US
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Telephone | 310-766-5947
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Fax | 855-292-8588
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOHN CHANG
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Credential | MD
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Telephone | 310-766-5947
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 77448
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License Number State | CA
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