Provider Demographics
NPI:1588658074
Name:CHANG, SOPHIA S (MD)
Entity Type:Individual
Prefix:DR
First Name:SOPHIA
Middle Name:S
Last Name:CHANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 W MARGARET ST
Mailing Address - Street 2:STE. #6
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-5273
Mailing Address - Country:US
Mailing Address - Phone:509-547-6086
Mailing Address - Fax:509-547-0649
Practice Address - Street 1:516 W MARGARET ST
Practice Address - Street 2:STE. #6
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-5273
Practice Address - Country:US
Practice Address - Phone:509-547-6086
Practice Address - Fax:509-547-0649
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-11
Last Update Date:2014-09-16
Deactivation Date:2006-03-25
Deactivation Code:
Reactivation Date:2006-03-30
Provider Licenses
StateLicense IDTaxonomies
WAMD00036177207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMD00036177OtherSTATE MEDICAL LICENSE
WAMD00036177OtherSTATE MEDICAL LICENSE
WAG71440Medicare UPIN