Provider Demographics
NPI:1346259595
Name:CHANG, JYH C (MD)
Entity Type:Individual
Prefix:DR
First Name:JYH
Middle Name:C
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 1:4126 MAINE AVE
Mailing Address - Street 2:
Mailing Address - City:BALDWIN PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91706-3306
Mailing Address - Country:US
Mailing Address - Phone:626-962-5141
Mailing Address - Fax:626-338-4191
Practice Address - Street 1:4126 MAINE AVE
Practice Address - Street 2:
Practice Address - City:BALDWIN PARK
Practice Address - State:CA
Practice Address - Zip Code:91706-3306
Practice Address - Country:US
Practice Address - Phone:626-962-5141
Practice Address - Fax:626-338-4191
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA46003207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0071680Medicaid
CA00A460031Medicaid
CAGR0071680Medicaid
CAW18846Medicare ID - Type UnspecifiedMEDICARE GROUP
CA00A460031Medicaid