Basic Information
| Provider Information | |||||||||
| NPI: | 1144780230 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHANG | ||||||||
| FirstName: | SIMON | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14445 OLIVE VIEW DR | ||||||||
| Address2: | DEPARTMENT OF MEDICINE, ROOM 2B-182 | ||||||||
| City: | SYLMAR | ||||||||
| State: | CA | ||||||||
| PostalCode: | 91342 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7472103205 | ||||||||
| FaxNumber: | 7472104573 | ||||||||
| Practice Location | |||||||||
| Address1: | 14445 OLIVE VIEW DR | ||||||||
| Address2: | DEPARTMENT OF MEDICINE, ROOM 2B-182 | ||||||||
| City: | SYLMAR | ||||||||
| State: | CA | ||||||||
| PostalCode: | 91342 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7472103205 | ||||||||
| FaxNumber: | 7472104573 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/23/2019 | ||||||||
| LastUpdateDate: | 07/20/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/22/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207R00000X | 20A19976 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.