Provider Demographics
NPI:1366465304
Name:CHANG, JOHNNY K (MD)
Entity Type:Individual
Prefix:
First Name:JOHNNY
Middle Name:K
Last Name:CHANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:16133 VENTURA BLVD
Mailing Address - Street 2:STE 470
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2402
Mailing Address - Country:US
Mailing Address - Phone:818-981-3818
Mailing Address - Fax:818-784-3106
Practice Address - Street 1:16133 VENTURA BLVD
Practice Address - Street 2:STE 470
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2402
Practice Address - Country:US
Practice Address - Phone:818-981-3818
Practice Address - Fax:818-784-3106
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2015-06-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA70618207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A786180Medicaid
CA00A786180Medicaid
H96166Medicare UPIN