Provider Demographics
NPI:1972780062
Name:SULLIVAN-CHANG, LORETTA (MD)
Entity Type:Individual
Prefix:DR
First Name:LORETTA
Middle Name:
Last Name:SULLIVAN-CHANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LORETTA
Other - Middle Name:
Other - Last Name:SULLIVAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4950 S YOSEMITE ST # F2-365
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-1349
Mailing Address - Country:US
Mailing Address - Phone:650-847-7287
Mailing Address - Fax:
Practice Address - Street 1:4950 S YOSEMITE ST # F2-365
Practice Address - Street 2:
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111
Practice Address - Country:US
Practice Address - Phone:650-847-7287
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-30
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA100131207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine