Provider Demographics
NPI:1114952470
Name:CHANG, DORRIE E FUNG (MD)
Entity Type:Individual
Prefix:
First Name:DORRIE
Middle Name:E FUNG
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 1:8501 WILSHIRE BLVD STE 150
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-3148
Mailing Address - Country:US
Mailing Address - Phone:310-248-7090
Mailing Address - Fax:310-248-7033
Practice Address - Street 1:8501 WILSHIRE BLVD STE 150
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-3148
Practice Address - Country:US
Practice Address - Phone:310-248-7090
Practice Address - Fax:310-248-7033
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA82050207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A820500Medicaid
CAWA82050AMedicare PIN