MEDICARE: DR. PAUL P 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	174400000X	Specialist	216277	NY

General Provider Information

NPI Number	:	1952390528
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL P CHANG MD

Provider Business Mailing Address
First Line	:	80 5TH AVE
Second Line	:	SUITE 1605
City	:	NEW YORK
State	:	NY
Zip	:	10011-8002
Country	:	US
Telephone Number	:	646-543-6396
Fax Number	:	212-647-1931

Provider Business Practice Location Address
First Line	:	80 5TH AVE
Second Line	:	SUITE 1605
City	:	NEW YORK
State	:	NY
Zip	:	10011-8002
Country	:	US
Telephone Number	:	646-543-6396
Fax Number	:	212-647-1931

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

Provider Enumeration Date	:	10/17/2005
Last Update Date	:	02/04/2016

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