Provider Demographics
NPI:1720020654
Name:CHANG, ELAINE YI-LIEN (MD)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:YI-LIEN
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 1:22506 MARINE VIEW DR S
Mailing Address - Street 2:SUITE 101
Mailing Address - City:DES MOINES
Mailing Address - State:WA
Mailing Address - Zip Code:98198-6906
Mailing Address - Country:US
Mailing Address - Phone:206-212-6909
Mailing Address - Fax:206-249-8203
Practice Address - Street 1:22506 MARINE VIEW DR S
Practice Address - Street 2:SUITE 101
Practice Address - City:DES MOINES
Practice Address - State:WA
Practice Address - Zip Code:98198-6906
Practice Address - Country:US
Practice Address - Phone:206-212-6906
Practice Address - Fax:206-249-8203
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2014-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00036545207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG74870Medicare UPIN