Provider Demographics
NPI:1073531554
Name:CHANG, AIMEE S (MD)
Entity Type:Individual
Prefix:DR
First Name:AIMEE
Middle Name:S
Last Name:CHANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9370 SW GREENBURG RD
Mailing Address - Street 2:SUITE 412
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-5442
Mailing Address - Country:US
Mailing Address - Phone:503-292-7734
Mailing Address - Fax:503-292-7735
Practice Address - Street 1:9370 SW GREENBURG RD
Practice Address - Street 2:SUITE 412
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97223-5442
Practice Address - Country:US
Practice Address - Phone:503-292-7734
Practice Address - Fax:503-292-7735
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002005827207VE0102X
ORMD27368207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
157258OtherMO-BLUE SHIELD
H56416Medicare UPIN