Provider Demographics
NPI:1760594097
Name:CHANG, SIMON Y (MD)
Entity Type:Individual
Prefix:DR
First Name:SIMON
Middle Name:Y
Last Name:CHANG
Suffix:
Gender:M
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:PO BOX 1088
Mailing Address - Street 2:
Mailing Address - City:ARTESIA
Mailing Address - State:CA
Mailing Address - Zip Code:90702-1088
Mailing Address - Country:US
Mailing Address - Phone:714-443-4512
Mailing Address - Fax:562-286-8777
Practice Address - Street 1:10441 LAKEWOOD BLVD STE AB
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-2744
Practice Address - Country:US
Practice Address - Phone:562-869-1070
Practice Address - Fax:562-286-8777
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA69205207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A692050Medicaid
CA00A692050Medicaid