Provider Demographics
NPI:1982898409
Name:CHANG, HEATHER S (MD)
Entity type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:S
Last Name:CHANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:234 S. FIRST AVE, SUITE 101
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006
Mailing Address - Country:US
Mailing Address - Phone:626-447-7008
Mailing Address - Fax:626-447-7009
Practice Address - Street 1:234 S. FIRST AVE, SUITE 101
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006
Practice Address - Country:US
Practice Address - Phone:626-447-7008
Practice Address - Fax:626-447-7009
Is Sole Proprietor?:No
Enumeration Date:2007-08-28
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD448260207W00000X, 207WX0107X
NY287240207WX0107X
CAA103063207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04679407Medicaid
NYJ400367669OtherMEDICARE PTAN