Provider Demographics
NPI:1356784441
Name:CHANG, ANDREW E-KONG (MD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:E-KONG
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 1:520 EATON AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45013-2716
Mailing Address - Country:US
Mailing Address - Phone:513-867-1200
Mailing Address - Fax:513-867-1266
Practice Address - Street 1:520 EATON AVE STE 200
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45013-2716
Practice Address - Country:US
Practice Address - Phone:513-867-1200
Practice Address - Fax:513-867-1266
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-09
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY51355207V00000X
OH35.137264207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0325648Medicaid