Provider Demographics
NPI:1194704478
Name:CHANG, JENG YUE (MD)
Entity type:Individual
Prefix:
First Name:JENG
Middle Name:YUE
Last Name:CHANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10212 5TH AVE NE #100
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-7471
Mailing Address - Country:US
Mailing Address - Phone:206-362-2127
Mailing Address - Fax:206-364-9655
Practice Address - Street 1:10212 5TH AVE NE #100
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-7471
Practice Address - Country:US
Practice Address - Phone:206-362-2127
Practice Address - Fax:206-364-9655
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-13
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00027322207N00000X, 207NI0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NI0002XAllopathic & Osteopathic PhysiciansDermatologyClinical & Laboratory Dermatological Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1064559Medicaid
WA56722OtherLABOR & INDUSTRIES
CH4229OtherREGENCE BLUESHIELD
WAG000108453Medicare ID - Type Unspecified
D38691Medicare UPIN