Provider Demographics
NPI:1649221383
Name:CHANG, EMERY H (MD)
Entity Type:Individual
Prefix:DR
First Name:EMERY
Middle Name:H
Last Name:CHANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1399 ROXBURY DR
Mailing Address - Street 2:STE 100
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-4709
Mailing Address - Country:US
Mailing Address - Phone:310-557-2273
Mailing Address - Fax:310-557-3450
Practice Address - Street 1:1399 ROXBURY DR
Practice Address - Street 2:STE 100
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-4709
Practice Address - Country:US
Practice Address - Phone:310-557-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA91316207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I45722Medicare UPIN
CABF178ZMedicare PIN