Provider Demographics
NPI:1669008058
Name:CHANG, MICHELLE JI HYE
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:JI HYE
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 1:360 W AVENUE 26 APT 423
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90031-1490
Mailing Address - Country:US
Mailing Address - Phone:213-255-8805
Mailing Address - Fax:
Practice Address - Street 1:360 W AVENUE 26 APT 423
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90031-1490
Practice Address - Country:US
Practice Address - Phone:213-255-8805
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-17
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant