Provider Demographics
NPI:1912631680
Name:BASLER-CHANG, KAI LI CARL
Entity Type:Individual
Prefix:
First Name:KAI
Middle Name:LI CARL
Last Name:BASLER-CHANG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2233 W MAIN ST APT N
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-6545
Mailing Address - Country:US
Mailing Address - Phone:413-687-5534
Mailing Address - Fax:
Practice Address - Street 1:540 S EREMLAND DR
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91723
Practice Address - Country:US
Practice Address - Phone:626-966-1577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-10
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily