MEDICARE: MR. EDWARD KEE CHANG

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	225X00000X	Occupational Therapist	OT7095	CA

General Provider Information

NPI Number	:	1902963135
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. EDWARD KEE CHANG

Provider Business Mailing Address
First Line	:	5300 SANTA MONICA BLVD
Second Line	:	SUITE 414
City	:	LOS ANGELES
State	:	CA
Zip	:	90029-1131
Country	:	US
Telephone Number	:	323-871-1677
Fax Number	:	323-871-1677

Provider Business Practice Location Address
First Line	:	5300 SANTA MONICA BLVD
Second Line	:	SUITE 414
City	:	LOS ANGELES
State	:	CA
Zip	:	90029-1131
Country	:	US
Telephone Number	:	323-871-1677
Fax Number	:	323-871-1677

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

Provider Enumeration Date	:	01/03/2007
Last Update Date	:	07/08/2007

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Directions to “ MR. EDWARD KEE CHANG ” Practice Location

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