Provider Demographics
NPI:1013975986
Name:CHANG, CHIA-WAI DAVID (MD)
Entity Type:Individual
Prefix:
First Name:CHIA-WAI
Middle Name:DAVID
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:PO BOX 7687
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65205-7687
Mailing Address - Country:US
Mailing Address - Phone:573-817-3000
Mailing Address - Fax:573-875-6950
Practice Address - Street 1:812 N KEENE ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-6633
Practice Address - Country:US
Practice Address - Phone:573-817-3000
Practice Address - Fax:573-876-6950
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005023723207YX0007X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO714647OtherHEALTHLINK
MO207427808Medicaid
MO184460OtherBLUE SHIELD
MO184460OtherBLUE CHOICE
MOP00259186Medicare PIN
MO207427808Medicaid
MO935021109Medicare PIN
MOP00419186Medicare PIN
MO184460OtherBLUE CHOICE