Provider Demographics
NPI:1003926189
Name:CHANG, PETER H (DO)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:H
Last Name:CHANG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 821350
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98682-0030
Mailing Address - Country:US
Mailing Address - Phone:360-687-5221
Mailing Address - Fax:360-666-0466
Practice Address - Street 1:300 N GRAHAM ST STE 250
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-1666
Practice Address - Country:US
Practice Address - Phone:503-280-3418
Practice Address - Fax:503-284-7885
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP000020952080P0202X
ORDO267362080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1123090OtherMEDICAID
OR213128Medicaid
WA8900127Medicare PIN