Provider Demographics
NPI:1194401422
Name:RYAN CHANG, DPM, INC.
Entity type:Organization
Organization Name:RYAN CHANG, DPM, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:WON
Authorized Official - Middle Name:HO
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:949-484-4405
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:201-981-3166
Mailing Address - Fax:
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-22
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty