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General NPI Number Information
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NPI Number | 1669451738
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Entity Type | Individual
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Provider Name | KEON CHANG M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/17/2006
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Last Update Date | 10/21/2009
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Provider Practice Location Address
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Address Line | 2001 S MERRIMAN RD
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City | WESTLAND
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State | MI
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Zip | 48186-5544
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Country | US
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Telephone | 734-729-3133
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Fax |
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Provider Business Mailing Address
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Address Line | 5623 E DUNBAR RD
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City | MONROE
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State | MI
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Zip | 48161-9127
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Country | US
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Telephone | 734-241-3891
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Fax | 734-241-0014
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 4301037628
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 037628
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License Number State | MI
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