Provider Demographics
NPI:1629151212
Name:CHANG, LIAN S (MD)
Entity Type:Individual
Prefix:
First Name:LIAN
Middle Name:S
Last Name:CHANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
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Mailing Address - Street 1:10751 LYNDALE BLUFFS TRL
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55420-5652
Mailing Address - Country:US
Mailing Address - Phone:651-628-0368
Mailing Address - Fax:651-636-7273
Practice Address - Street 1:10751 LYNDALE BLUFFS TRL
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55420-5652
Practice Address - Country:US
Practice Address - Phone:651-628-0368
Practice Address - Fax:651-636-7273
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2018-03-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN387662084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN25522000Medicaid