Provider Demographics
NPI:1346391182
Name:CHANG, JOYCE PO (MD)
Entity type:Individual
Prefix:
First Name:JOYCE
Middle Name:PO
Last Name:CHANG
Suffix:
Gender:F
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:PO BOX 81316
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89180-1316
Mailing Address - Country:US
Mailing Address - Phone:702-228-9888
Mailing Address - Fax:702-750-1667
Practice Address - Street 1:7720 W SAHARA AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117
Practice Address - Country:US
Practice Address - Phone:702-228-9888
Practice Address - Fax:702-228-1388
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV12643207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1346391182Medicaid
NVBD399XMedicare PIN
I01562Medicare UPIN