Provider Demographics
NPI:1073012720
Name:CHANG, WON HO (DPM)
Entity type:Individual
Prefix:DR
First Name:WON
Middle Name:HO
Last Name:CHANG
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:DR
Other - First Name:RYAN
Other - Middle Name:
Other - Last Name:CHANG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM
Mailing Address - Street 1:46 SNAPDRAGON
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-2844
Mailing Address - Country:US
Mailing Address - Phone:949-484-4405
Mailing Address - Fax:949-368-2230
Practice Address - Street 1:62 CORPORATE PARK STE 235
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92606-3123
Practice Address - Country:US
Practice Address - Phone:949-484-4405
Practice Address - Fax:949-368-2230
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-08
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP84589213E00000X
CAE5908213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC31877880004751OtherPODIATRY