Provider Demographics
NPI:1700879343
Name:CHANG, BRIAN MYUNG (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:MYUNG
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 1:4800 N 22ND ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-4701
Mailing Address - Country:US
Mailing Address - Phone:480-892-8400
Mailing Address - Fax:480-654-2868
Practice Address - Street 1:270 S CANDY LN
Practice Address - Street 2:
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326-4164
Practice Address - Country:US
Practice Address - Phone:480-892-8400
Practice Address - Fax:480-892-9533
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ34356207W00000X, 207WX0009X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0009XAllopathic & Osteopathic PhysiciansOphthalmologyGlaucoma Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMH54679Medicare UPIN
AZZ109553Medicare PIN
AZZ109551Medicare PIN
AZZ109552Medicare PIN
AZZ109555Medicare PIN
AZZ109554Medicare PIN