Provider Demographics
NPI:1578644217
Name:CHANG, PATRICK KUNG SUN (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:KUNG SUN
Last Name:CHANG
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:101 OLD SHORT HILLS RD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-1023
Mailing Address - Country:US
Mailing Address - Phone:973-731-5005
Mailing Address - Fax:973-325-6230
Practice Address - Street 1:101 OLD SHORT HILLS RD
Practice Address - Street 2:SUITE 206
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-1023
Practice Address - Country:US
Practice Address - Phone:973-731-5005
Practice Address - Fax:973-325-6230
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMA29139208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1836005Medicaid
124771PTFMedicare PIN
NJ1836005Medicaid