Provider Demographics
NPI:1316910243
Name:CHANG, KAE (MD)
Entity type:Individual
Prefix:
First Name:KAE
Middle Name:
Last Name:CHANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:224 S WOODS MILL RD
Mailing Address - Street 2:SUITE 435 SOUTH
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-3513
Mailing Address - Country:US
Mailing Address - Phone:314-576-2394
Mailing Address - Fax:314-590-5937
Practice Address - Street 1:224 S WOODS MILL RD
Practice Address - Street 2:SUITE 435 SOUTH
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-3513
Practice Address - Country:US
Practice Address - Phone:314-576-2394
Practice Address - Fax:314-590-5937
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2017-03-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO108257207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1316910243Medicaid
MO203819313Medicaid
MOG80090Medicare UPIN
MO203819313Medicaid