Basic Information
| Provider Information | |||||||||
| NPI: | 1376583302 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHANG | ||||||||
| FirstName: | DONG | ||||||||
| MiddleName: | WOOK | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4101 WHITMAN AVE N # B | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981037821 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2066323093 | ||||||||
| FaxNumber: | 2066323093 | ||||||||
| Practice Location | |||||||||
| Address1: | 505 S 336TH STREET | ||||||||
| Address2: | |||||||||
| City: | FEDERAL WAY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980036328 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2538386180 | ||||||||
| FaxNumber: | 2538386418 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2006 | ||||||||
| LastUpdateDate: | 07/18/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD00043595 | WA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | MD00043595 | WA | N | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 0202038 | 01 | WA | LIWA | OTHER | 1056CH | 01 | WA | BSWA | OTHER | 8438459 | 05 | WA | MEDICAID |