Provider Demographics
NPI:1699064006
Name:CHANG, RUEY JEN (PA)
Entity type:Individual
Prefix:
First Name:RUEY
Middle Name:JEN
Last Name:CHANG
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5451 LA PALMA AVE
Mailing Address - Street 2:SUITE 25
Mailing Address - City:LA PALMA
Mailing Address - State:CA
Mailing Address - Zip Code:90623-1728
Mailing Address - Country:US
Mailing Address - Phone:714-670-1340
Mailing Address - Fax:714-443-3780
Practice Address - Street 1:5451 LA PALMA AVE
Practice Address - Street 2:SUITE 25
Practice Address - City:LA PALMA
Practice Address - State:CA
Practice Address - Zip Code:90623-1728
Practice Address - Country:US
Practice Address - Phone:714-670-1340
Practice Address - Fax:714-443-3780
Is Sole Proprietor?:No
Enumeration Date:2011-04-06
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA20204363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA20204OtherPHYSICIAN ASSISTANT LICENSE