Provider Demographics
NPI:1649844085
Name:CHANG, OLIVIA WEI (PA-C)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:WEI
Last Name:CHANG
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 W LA VETA AVE STE 430
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4226
Mailing Address - Country:US
Mailing Address - Phone:714-543-5555
Mailing Address - Fax:
Practice Address - Street 1:1140 W LA VETA AVE STE 430
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4226
Practice Address - Country:US
Practice Address - Phone:714-543-5555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-19
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA63012363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant