Provider Demographics
NPI:1902963135
Name:CHANG, EDWARD KEE
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:KEE
Last Name:CHANG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5300 SANTA MONICA BLVD
Mailing Address - Street 2:SUITE 414
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90029-1131
Mailing Address - Country:US
Mailing Address - Phone:323-871-1677
Mailing Address - Fax:323-871-1677
Practice Address - Street 1:5300 SANTA MONICA BLVD
Practice Address - Street 2:SUITE 414
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90029-1131
Practice Address - Country:US
Practice Address - Phone:323-871-1677
Practice Address - Fax:323-871-1677
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT7095225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWOT7095AMedicare ID - Type UnspecifiedPROVIDER # WITHIN GROUP
CAOT7095Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER