Provider Demographics
NPI:1154594794
Name:EDWIN Y CHANG MD PLLC
Entity type:Organization
Organization Name:EDWIN Y CHANG MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:Y
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-484-1212
Mailing Address - Street 1:235 E ROWAN AVE
Mailing Address - Street 2:STE 206
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99207-1240
Mailing Address - Country:US
Mailing Address - Phone:509-484-1212
Mailing Address - Fax:509-484-1277
Practice Address - Street 1:235 E ROWAN AVE
Practice Address - Street 2:STE 206
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99207-1240
Practice Address - Country:US
Practice Address - Phone:509-484-1212
Practice Address - Fax:509-484-1277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-03
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1124940Medicaid
WA8947213OtherVICTIM'S OF CRIME PROVIDER #
WA0230584OtherLABOR & INDUSTRIES PROVIDER #
2355CHOtherASURIS
WA1124940Medicaid
G8874402Medicare PIN