Basic Information
| Provider Information | |||||||||
| NPI: | 1831144104 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KU JUEY RAYMOND CHANG INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 23141 MOULTON PKWY STE 102 | ||||||||
| Address2: | |||||||||
| City: | LAGUNA HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926531241 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9499169100 | ||||||||
| FaxNumber: | 9499160091 | ||||||||
| Practice Location | |||||||||
| Address1: | 23141 MOULTON PKWY STE 102 | ||||||||
| Address2: | |||||||||
| City: | LAGUNA HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926531241 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9499169100 | ||||||||
| FaxNumber: | 9499160091 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2006 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| AuthorizedOfficialLastName: | CHANG | ||||||||
| AuthorizedOfficialFirstName: | KU-JUEY RAYMOND | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF EXECUTIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 9499169100 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | 207RE0101X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism |
No ID Information.