Provider Demographics
NPI:1922270412
Name:MEDICAL NEUROLOGY CHANG LTD
Entity Type:Organization
Organization Name:MEDICAL NEUROLOGY CHANG LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BESS
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:702-851-1065
Mailing Address - Street 1:PO BOX 777910
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89077-7910
Mailing Address - Country:US
Mailing Address - Phone:702-851-1065
Mailing Address - Fax:702-851-1066
Practice Address - Street 1:8530 W SUNSET RD
Practice Address - Street 2:SUTE 350
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-2215
Practice Address - Country:US
Practice Address - Phone:702-851-1065
Practice Address - Fax:702-851-1066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-25
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV10562084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AV126Medicare PIN