Provider Demographics
NPI:1407238991
Name:CHANG, LI-YANG
Entity Type:Individual
Prefix:
First Name:LI-YANG
Middle Name:
Last Name:CHANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3791 DOLAN WAY
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46074-8358
Mailing Address - Country:US
Mailing Address - Phone:317-268-8525
Mailing Address - Fax:317-268-8526
Practice Address - Street 1:3791 DOLAN WAY
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46074-8358
Practice Address - Country:US
Practice Address - Phone:317-268-8525
Practice Address - Fax:317-268-8526
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-22
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY671837163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse