Provider Demographics
NPI:1235295023
Name:CHANG, CHIN-YUNG PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:CHIN-YUNG
Middle Name:PAUL
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 1:7111 FAIRWAY DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33418-4204
Mailing Address - Country:US
Mailing Address - Phone:800-330-6565
Mailing Address - Fax:561-712-7349
Practice Address - Street 1:1710 HARPER RD
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-3357
Practice Address - Country:US
Practice Address - Phone:304-256-4161
Practice Address - Fax:304-256-3011
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301073051207ZP0102X
WV17454207ZP0102X, 207ZH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZH0000XAllopathic & Osteopathic PhysiciansPathologyHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
020G312370OtherBLUE CROSS/BLUE SHIELD
MI5197007Medicaid
MI5197007Medicaid
020G312370OtherBLUE CROSS/BLUE SHIELD
MI0942010004Medicare PIN