Provider Demographics
NPI:1558537365
Name:CHANG, LI-WEN
Entity Type:Individual
Prefix:
First Name:LI-WEN
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 1:1021 SCANDIA AVE APT 115
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93004-2466
Mailing Address - Country:US
Mailing Address - Phone:909-520-7711
Mailing Address - Fax:
Practice Address - Street 1:1021 SCANDIA AVE APT 115
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93004-2466
Practice Address - Country:US
Practice Address - Phone:909-520-7711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health