Provider Demographics
NPI:1033152087
Name:CHANG, YUN TAE (MD)
Entity Type:Individual
Prefix:DR
First Name:YUN
Middle Name:TAE
Last Name:CHANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4902 EISENHOWER BLVD.
Mailing Address - Street 2:SUITE 300
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-6344
Mailing Address - Country:US
Mailing Address - Phone:813-636-2000
Mailing Address - Fax:813-463-1801
Practice Address - Street 1:4211 VANDYKE ROAD
Practice Address - Street 2:SUITE 200
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33558-8005
Practice Address - Country:US
Practice Address - Phone:813-321-6237
Practice Address - Fax:813-463-1801
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0073300207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL270807800Medicaid
FL270807800Medicaid
FL41436YMedicare PIN
FL41436ZMedicare PIN