Basic Information
| Provider Information | |||||||||
| NPI: | 1700908019 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHANG | ||||||||
| FirstName: | EDWIN | ||||||||
| MiddleName: | YAO-YUAN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1400 E KINCAID ST | ||||||||
| Address2: | ATTN: CREDENTIALING | ||||||||
| City: | MOUNT VERNON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982744127 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3604282500 | ||||||||
| FaxNumber: | 3604286485 | ||||||||
| Practice Location | |||||||||
| Address1: | 1400 E KINCAID ST | ||||||||
| Address2: | |||||||||
| City: | MOUNT VERNON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982744127 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3604282586 | ||||||||
| FaxNumber: | 3604286470 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/06/2007 | ||||||||
| LastUpdateDate: | 06/19/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208200000X | MD00049137 | WA | N | Allopathic & Osteopathic Physicians | Plastic Surgery | 2082S0099X | MD00049137 | WA | N | Allopathic & Osteopathic Physicians | Plastic Surgery | Plastic Surgery Within the Head and Neck | 2082S0105X | MD00049137 | WA | N | Allopathic & Osteopathic Physicians | Plastic Surgery | Surgery of the Hand | 2086S0122X | MD00049137 | WA | Y | Allopathic & Osteopathic Physicians | Surgery | Plastic and Reconstructive Surgery |
ID Information
| ID | Type | State | Issuer | Description | 0261838 | 01 | WA | LABOR & INDUSTRIES | OTHER | 0261838 | 01 | WA | VICTIM'S OF CRIM | OTHER | 170090819 | 05 | WA | MEDICAID | P00840095 | 01 | MEDICARE RAILROAD | OTHER |