Provider Demographics
NPI:1952390528
Name:CHANG, PAUL P (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:P
Last Name:CHANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 5TH AVE
Mailing Address - Street 2:SUITE 1605
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-8002
Mailing Address - Country:US
Mailing Address - Phone:646-543-6396
Mailing Address - Fax:212-647-1931
Practice Address - Street 1:80 5TH AVE
Practice Address - Street 2:SUITE 1605
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-8002
Practice Address - Country:US
Practice Address - Phone:646-543-6396
Practice Address - Fax:212-647-1931
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-17
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY216277174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400013754Medicare UPIN