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General NPI Number Information
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NPI Number | 1700152253
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Entity Type | Individual
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Provider Name | TRACY CHANG MD
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Gender | Female
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Dates
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Enumeration Date | 03/29/2012
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Last Update Date | 07/26/2024
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Provider Practice Location Address
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Address Line | 401 15TH AVE SE
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City | PUYALLUP
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State | WA
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Zip | 98372-3795
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Country | US
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Telephone | 253-697-4000
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Fax |
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Provider Business Mailing Address
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Address Line | 400 E PIONEER STE 101
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City | PUYALLUP
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State | WA
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Zip | 98372-3256
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Country | US
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Telephone | 534-455-8282
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 60717491
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License Number State | WA
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