Provider Demographics
NPI:1477131373
Name:CHANG, YOUNG IL (PHARMD)
Entity Type:Individual
Prefix:
First Name:YOUNG IL
Middle Name:
Last Name:CHANG
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 E HILL ST
Mailing Address - Street 2:
Mailing Address - City:SIGNAL HILL
Mailing Address - State:CA
Mailing Address - Zip Code:90755-3612
Mailing Address - Country:US
Mailing Address - Phone:562-988-2278
Mailing Address - Fax:
Practice Address - Street 1:1600 E HILL ST
Practice Address - Street 2:
Practice Address - City:SIGNAL HILL
Practice Address - State:CA
Practice Address - Zip Code:90755-3612
Practice Address - Country:US
Practice Address - Phone:562-988-2278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-31
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS50987183500000X
CARPH80740183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist