Provider Demographics
NPI:1487627261
Name:CHANG, PAUL SOOJIN (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:SOOJIN
Last Name:CHANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2654 W LA PALMA AVE
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-2601
Mailing Address - Country:US
Mailing Address - Phone:714-827-0700
Mailing Address - Fax:714-827-2367
Practice Address - Street 1:5832 BEACH BLVD UNIT 214
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90621-5501
Practice Address - Country:US
Practice Address - Phone:714-523-7575
Practice Address - Fax:714-523-7585
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG077288207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G772880Medicaid
WG77288EMedicare ID - Type Unspecified
CAG05811Medicare UPIN