Provider Demographics
NPI:1740430289
Name:CHANG, HENRY (DO)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:
Last Name:CHANG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2707 E VALLEY BLVD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91792-3195
Mailing Address - Country:US
Mailing Address - Phone:626-581-0486
Mailing Address - Fax:626-581-0161
Practice Address - Street 1:2707 E VALLEY BLVD
Practice Address - Street 2:SUITE 208
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91792-3195
Practice Address - Country:US
Practice Address - Phone:626-581-0486
Practice Address - Fax:626-581-0161
Is Sole Proprietor?:No
Enumeration Date:2008-09-21
Last Update Date:2010-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A10516207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine