Provider Demographics
NPI:1881681914
Name:CHANG, MICHAEL YUECHIA (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:YUECHIA
Last Name:CHANG
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4760 W SUNSET BLVD FL 3
Mailing Address - Street 2:KAISER PERMANENTE LOS ANGELES MEDICAL CENTER
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-6063
Mailing Address - Country:US
Mailing Address - Phone:323-783-7510
Mailing Address - Fax:
Practice Address - Street 1:4760 W SUNSET BLVD FL 3
Practice Address - Street 2:KAISER PERMANENTE LOS ANGELES MEDICAL CENTER
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-6063
Practice Address - Country:US
Practice Address - Phone:323-783-7510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG87840208G00000X
MA205340208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0177300Medicaid
MAA34488Medicare ID - Type Unspecified
H67997Medicare UPIN