Provider Demographics
NPI:1356644876
Name:CHANG, YOLANDA I (MD)
Entity Type:Individual
Prefix:DR
First Name:YOLANDA
Middle Name:I
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 1:7 BLANCHARD CIR
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60189-2037
Mailing Address - Country:US
Mailing Address - Phone:630-668-0833
Mailing Address - Fax:630-668-7685
Practice Address - Street 1:7 BLANCHARD CIR
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60189-2037
Practice Address - Country:US
Practice Address - Phone:630-668-0833
Practice Address - Fax:630-668-7685
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-07
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036133750208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036133750Medicaid
IL206147OtherMEDICARE (GROUP)
ILF400093496OtherMEDICARE (INDIVIDUAL)