Provider Demographics
NPI:1376583302
Name:CHANG, DONG WOOK (MD)
Entity Type:Individual
Prefix:
First Name:DONG
Middle Name:WOOK
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 1:4101 WHITMAN AVE N # B
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-7821
Mailing Address - Country:US
Mailing Address - Phone:206-632-3093
Mailing Address - Fax:206-632-3093
Practice Address - Street 1:505 S 336TH STREET
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-6328
Practice Address - Country:US
Practice Address - Phone:253-838-6180
Practice Address - Fax:253-838-6418
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00043595207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0202038OtherLIWA
WA1056CHOtherBSWA
WA8438459Medicaid
WAP00378902Medicare PIN
WA1056CHOtherBSWA
WA0202038OtherLIWA