Provider Demographics
NPI:1245225341
Name:CHANG, CHUAN (MD)
Entity Type:Individual
Prefix:
First Name:CHUAN
Middle Name:
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 1:185 CANAL ST
Mailing Address - Street 2:STE. 501
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-4537
Mailing Address - Country:US
Mailing Address - Phone:212-226-8819
Mailing Address - Fax:212-226-2199
Practice Address - Street 1:185 CANAL ST
Practice Address - Street 2:STE. 501
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-4537
Practice Address - Country:US
Practice Address - Phone:212-226-8819
Practice Address - Fax:212-226-2199
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-14
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2180522080P0008X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0008XAllopathic & Osteopathic PhysiciansPediatricsNeurodevelopmental Disabilities
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2204416OtherUNITED HEALTH CARE
NY2604257OtherGHI
NY613Z11OtherEMPIRE BCBS
NY0101763-01OtherAMERICHOICE
NY3016608OtherUSHC HMO
NYP2665019OtherOXFORD HEALTH
NY218052OtherHIP
NY218052-A15OtherHEALTH FIRST
NY4C4893OtherHEALTH NET
NY02288791Medicaid
NY7085418OtherAETNA PPO
NY1000033730OtherAFFINITY HEALTH
NY613Z11OtherEMPIRE BCBS
NYH78191Medicare UPIN