Provider Demographics
NPI:1508886508
Name:CHANG, PATRICIA J (MD)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:J
Last Name:CHANG
Suffix:
Gender:F
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:2080 CENTURY PARK E
Mailing Address - Street 2:SUITE 1609
Mailing Address - City:CENTURY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90067-2001
Mailing Address - Country:US
Mailing Address - Phone:310-556-8899
Mailing Address - Fax:310-552-0014
Practice Address - Street 1:2080 CENTURY PARK E
Practice Address - Street 2:SUITE 1609
Practice Address - City:CENTURY CITY
Practice Address - State:CA
Practice Address - Zip Code:90067-2001
Practice Address - Country:US
Practice Address - Phone:310-556-8899
Practice Address - Fax:310-552-0014
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2014-01-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG76535207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA615476Medicare UPIN
CAG15476Medicare UPIN