Basic Information
| Provider Information | |||||||||
| NPI: | 1811284193 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHANG | ||||||||
| FirstName: | ELISA | ||||||||
| MiddleName: | LEE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1449 | ||||||||
| Address2: | |||||||||
| City: | BREA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928221449 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7149961633 | ||||||||
| FaxNumber: | 7149962967 | ||||||||
| Practice Location | |||||||||
| Address1: | 950 S ARROYO PKWY | ||||||||
| Address2: | FL 3 | ||||||||
| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911053932 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6263040782 | ||||||||
| FaxNumber: | 6266582848 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2011 | ||||||||
| LastUpdateDate: | 03/02/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/02/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0200X | 261622-1 | NY | N | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease | 207RI0200X | A117197 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease |
No ID Information.