MEDICARE: JENG YUE CHANG MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	MD00027322	WA
2	207NI0002X	Clinical & Laboratory Dermatological Immunology Physician	MD00027322	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	56722	OTHER	WA	LABOR & INDUSTRIES
3	CH4229	OTHER		REGENCE BLUESHIELD

General Provider Information

NPI Number	:	1194704478
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENG YUE CHANG MD

Provider Business Mailing Address
First Line	:	10212 5TH AVE NE #100
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98125-7471
Country	:	US
Telephone Number	:	206-362-2127
Fax Number	:	206-364-9655

Provider Business Practice Location Address
First Line	:	10212 5TH AVE NE #100
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98125-7471
Country	:	US
Telephone Number	:	206-362-2127
Fax Number	:	206-364-9655

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/13/2006
Last Update Date	:	08/07/2007

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Directions to “ JENG YUE CHANG MD” Practice Location

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