Provider Demographics
NPI:1992787618
Name:CHANG, WON S (MD)
Entity type:Individual
Prefix:DR
First Name:WON
Middle Name:S
Last Name:CHANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 780595
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-0595
Mailing Address - Country:US
Mailing Address - Phone:800-331-9294
Mailing Address - Fax:812-962-6425
Practice Address - Street 1:9910 ROOSEVELT BLVD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19115-1705
Practice Address - Country:US
Practice Address - Phone:215-658-4669
Practice Address - Fax:215-671-4307
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2022-02-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD071181L2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018183900003Medicaid
PA910876OtherBCBS PA
PA1127966OtherKEYSTONE MERCY
PA0811079000OtherKEYSTONE 65
PA920006241OtherRAILROAD MEDICARE
PA0018183900001Medicaid
PA0711079000OtherKEYSTONE HEALTH PLAN EAST
PA0811079000OtherKEYSTONE 65
PA0711079000OtherKEYSTONE HEALTH PLAN EAST