Basic Information
| Provider Information | |||||||||
| NPI: | 1750606703 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KEC CHANG MEDICAL ASSOCIATES, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 81316 | ||||||||
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| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891801316 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7022289888 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7720 W SAHARA AVE | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891172799 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7022289888 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/01/2010 | ||||||||
| LastUpdateDate: | 04/16/2018 | ||||||||
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| AuthorizedOfficialLastName: | CHANG | ||||||||
| AuthorizedOfficialFirstName: | JOYCE | ||||||||
| AuthorizedOfficialMiddleName: | P | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7022289888 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 12643 | NV | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.