Provider Demographics
NPI:1033106034
Name:CHANG, CHUN-YANG MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:CHUN-YANG
Middle Name:MICHAEL
Last Name:CHANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:C-Y
Other - Middle Name:MICHAEL
Other - Last Name:CHANG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:541 NE 20TH AVE STE 225
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-2895
Mailing Address - Country:US
Mailing Address - Phone:503-963-2801
Mailing Address - Fax:503-963-2825
Practice Address - Street 1:1508 DIVISION ST
Practice Address - Street 2:STE 15
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-1582
Practice Address - Country:US
Practice Address - Phone:503-692-3750
Practice Address - Fax:503-691-2324
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD23576207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1033106034Medicaid
OR286972Medicaid
112259Medicare ID - Type Unspecified
WA1033106034Medicaid
OR171915Medicare PIN
OR286972Medicaid
ORP01424923Medicare PIN
OR171328Medicare PIN