Provider Demographics
NPI:1891909545
Name:CHANG, BEN WAYUAN (MD)
Entity Type:Individual
Prefix:DR
First Name:BEN
Middle Name:WAYUAN
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 1:11600 WEST SECOND PLACE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228
Mailing Address - Country:US
Mailing Address - Phone:720-321-1100
Mailing Address - Fax:303-397-2004
Practice Address - Street 1:11600 W 2ND PL
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-1527
Practice Address - Country:US
Practice Address - Phone:720-321-1000
Practice Address - Fax:303-397-2004
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO46764207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
329480174Medicare PIN
P00444710Medicare PIN
200879708Medicare PIN
200879708Medicare PIN