Provider Demographics
NPI:1831161959
Name:WANG, CHANG-YANG (MD)
Entity type:Individual
Prefix:DR
First Name:CHANG-YANG
Middle Name:
Last Name:WANG
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 1:4901 W 79TH ST
Mailing Address - Street 2:6
Mailing Address - City:BURBANK
Mailing Address - State:IL
Mailing Address - Zip Code:60459-1554
Mailing Address - Country:US
Mailing Address - Phone:708-425-1320
Mailing Address - Fax:708-425-1312
Practice Address - Street 1:4901 W 79TH ST
Practice Address - Street 2:6
Practice Address - City:BURBANK
Practice Address - State:IL
Practice Address - Zip Code:60459-1554
Practice Address - Country:US
Practice Address - Phone:708-425-1320
Practice Address - Fax:708-425-1312
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL21606779OtherBLUE CROSS/ BLUE SHIELD
ILD13097Medicare UPIN
IL491080Medicare ID - Type Unspecified