Provider Demographics
NPI:1881745172
Name:EMERY J CHANG LLC
Entity type:Organization
Organization Name:EMERY J CHANG LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:EMERY
Authorized Official - Middle Name:J
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:253-984-6200
Mailing Address - Street 1:11300 BRIDGEPORT WAY SW
Mailing Address - Street 2:UNIT C
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-3052
Mailing Address - Country:US
Mailing Address - Phone:253-984-6200
Mailing Address - Fax:253-984-1100
Practice Address - Street 1:11300 BRIDGEPORT WAY SW
Practice Address - Street 2:UNIT C
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-3052
Practice Address - Country:US
Practice Address - Phone:253-984-6200
Practice Address - Fax:253-984-1100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00038868208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1116466Medicaid
WAAB37325Medicare ID - Type Unspecified
WA1116466Medicaid