Basic Information
| Provider Information | |||||||||
| NPI: | 1346391182 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHANG | ||||||||
| FirstName: | JOYCE | ||||||||
| MiddleName: | PO | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 81316 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891801316 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7022289888 | ||||||||
| FaxNumber: | 7027501667 | ||||||||
| Practice Location | |||||||||
| Address1: | 7720 W SAHARA AVE | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 89117 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7022289888 | ||||||||
| FaxNumber: | 7022281388 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/16/2007 | ||||||||
| LastUpdateDate: | 08/30/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 12643 | NV | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1346391182 | 05 | NV | MEDICAID |