Provider Demographics
NPI:1467197616
Name:CHANG, VIVIANNE MICHELLE (DO)
Entity Type:Individual
Prefix:DR
First Name:VIVIANNE
Middle Name:MICHELLE
Last Name:CHANG
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:VIVIANNE
Other - Middle Name:MICHELLE
Other - Last Name:CHANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:MSC09 5030 1 UNIVERSITY OF NEW MEXICO
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87131-0001
Mailing Address - Country:US
Mailing Address - Phone:505-272-8244
Mailing Address - Fax:505-272-4639
Practice Address - Street 1:MSC09 5030 1 UNIVERSITY OF NEW MEXICO
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87131-0001
Practice Address - Country:US
Practice Address - Phone:505-272-8244
Practice Address - Fax:505-272-4639
Is Sole Proprietor?:No
Enumeration Date:2022-05-02
Last Update Date:2023-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program