Basic Information
| Provider Information | |||||||||
| NPI: | 1568739233 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHANG | ||||||||
| FirstName: | JEFFREY | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12900 PARK PLAZA DR | ||||||||
| Address2: | SUITE 150, MS 7110 | ||||||||
| City: | CERRITOS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 907039329 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 10000 LAKEWOOD BLVD | ||||||||
| Address2: | |||||||||
| City: | DOWNEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902404020 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5628623684 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/24/2011 | ||||||||
| LastUpdateDate: | 09/19/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 20A12004 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.