Provider Demographics
NPI:1942436886
Name:CHANG, CHARLES Y (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
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 1:3124 S 19TH ST # 320
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-2433
Mailing Address - Country:US
Mailing Address - Phone:253-301-5100
Mailing Address - Fax:
Practice Address - Street 1:199 MOUNT EDEN PKWY
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-7703
Practice Address - Country:US
Practice Address - Phone:718-992-7669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-05
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60462997208800000X
IL125054599208800000X
NY314844208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology