Provider Demographics
NPI:1487693958
Name:CHANG, YOON O (MD)
Entity type:Individual
Prefix:
First Name:YOON
Middle Name:O
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:PO BOX 8488
Mailing Address - Street 2:
Mailing Address - City:ALTA LOMA
Mailing Address - State:CA
Mailing Address - Zip Code:91701-0488
Mailing Address - Country:US
Mailing Address - Phone:909-466-4231
Mailing Address - Fax:909-456-1255
Practice Address - Street 1:999 SAN BERNARDINO RD
Practice Address - Street 2:DEPARTMENT OF RADIOLOGY
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4920
Practice Address - Country:US
Practice Address - Phone:909-985-2811
Practice Address - Fax:909-456-1255
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350407812085R0202X
CAC515392085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0014700Medicaid
OH0452200Medicaid
CH0664495Medicare ID - Type Unspecified
OH0452200Medicaid
CAGR0014700Medicaid