Provider Demographics
NPI:1740504554
Name:CHANG, OLIVER (MD)
Entity type:Individual
Prefix:
First Name:OLIVER
Middle Name:
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 50095
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98145-5095
Mailing Address - Country:US
Mailing Address - Phone:206-543-6420
Mailing Address - Fax:
Practice Address - Street 1:1959 NE PACIFIC ST
Practice Address - Street 2:BOX 356100
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98195-6100
Practice Address - Country:US
Practice Address - Phone:206-598-6400
Practice Address - Fax:206-598-3803
Is Sole Proprietor?:No
Enumeration Date:2010-03-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60400506207ZD0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8947445OtherMEDICARE PIN
WA1740504554Medicaid