Provider Demographics
NPI:1982661575
Name:CHANG, PAIK HYUN (MD)
Entity Type:Individual
Prefix:DR
First Name:PAIK
Middle Name:HYUN
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 1:325 S WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90020-3804
Mailing Address - Country:US
Mailing Address - Phone:213-480-0404
Mailing Address - Fax:213-480-1519
Practice Address - Street 1:325 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90020-3804
Practice Address - Country:US
Practice Address - Phone:213-480-0404
Practice Address - Fax:213-480-1519
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA37230207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A372300Medicaid
CA00A372300Medicaid
CAA28337Medicare UPIN