Provider Demographics
NPI:1043309990
Name:CHANG, RAYMOND YEESUNG (MD)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:YEESUNG
Last Name:CHANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 E.30TH ST.,
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016
Mailing Address - Country:US
Mailing Address - Phone:212-683-1221
Mailing Address - Fax:212-683-1083
Practice Address - Street 1:102 E 30TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-7369
Practice Address - Country:US
Practice Address - Phone:212-683-1221
Practice Address - Fax:212-683-1083
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY166740207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP878982OtherOXFORD PROVIDER NUMBER
NY98D093OtherBLUECROSS PROVIDE NUMBER
NYP878982OtherOXFORD PROVIDER NUMBER