Provider Demographics
NPI:1952656613
Name:LISA CHANG MEDICAL CORPORATION
Entity Type:Organization
Organization Name:LISA CHANG MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:626-297-2101
Mailing Address - Street 1:1671 S AZUSA AVE
Mailing Address - Street 2:
Mailing Address - City:HACIENDA HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91745-3832
Mailing Address - Country:US
Mailing Address - Phone:626-208-3988
Mailing Address - Fax:626-210-2626
Practice Address - Street 1:1671 S AZUSA AVE
Practice Address - Street 2:
Practice Address - City:HACIENDA HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91745-3832
Practice Address - Country:US
Practice Address - Phone:626-208-3988
Practice Address - Fax:626-210-2626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-18
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A12080207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty