Provider Demographics
NPI:1104086750
Name:ELAINE Y CHANG, MD, INC
Entity type:Organization
Organization Name:ELAINE Y CHANG, MD, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:Y
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:206-248-8107
Mailing Address - Street 1:22506 MARINE VIEW DR S
Mailing Address - Street 2:SUITE 101
Mailing Address - City:DES MOINES
Mailing Address - State:WA
Mailing Address - Zip Code:98198-6906
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:22506 MARINE VIEW DR S
Practice Address - Street 2:SUITE 101
Practice Address - City:DES MOINES
Practice Address - State:WA
Practice Address - Zip Code:98198-6906
Practice Address - Country:US
Practice Address - Phone:206-439-2988
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-16
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00036545207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty