Provider Demographics
NPI:1578001665
Name:CHANG, ASIA
Entity Type:Individual
Prefix:
First Name:ASIA
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 1:170 S GREEN VALLEY PKWY
Mailing Address - Street 2:#300
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89012-3132
Mailing Address - Country:US
Mailing Address - Phone:702-900-7942
Mailing Address - Fax:
Practice Address - Street 1:170 S GREEN VALLEY PKWY
Practice Address - Street 2:#300
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89012-3132
Practice Address - Country:US
Practice Address - Phone:702-900-7942
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-08
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner