Basic Information
| Provider Information | |||||||||
| NPI: | 1134375512 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHANG | ||||||||
| FirstName: | PHILIP | ||||||||
| MiddleName: | HYUNGJIN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 636256 CENTRAL CREDENTIALING | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452636256 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5135855506 | ||||||||
| FaxNumber: | 5135855511 | ||||||||
| Practice Location | |||||||||
| Address1: | 525 E 68TH ST | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100654870 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6469622580 | ||||||||
| FaxNumber: | 2127465114 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2008 | ||||||||
| LastUpdateDate: | 09/22/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 35 128514 | OH | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | 036121683 | IL | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | A108083 | CA | N | Allopathic & Osteopathic Physicians | Surgery | 2086S0102X | 249593 | MA | N | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care | 2086S0102X | 296023 | NY | N | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care | 208600000X | 296023 | NY | Y | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.