Provider Demographics
NPI:1174593453
Name:CHANG, WESLEY JOHN (MD)
Entity type:Individual
Prefix:DR
First Name:WESLEY
Middle Name:JOHN
Last Name:CHANG
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:6200 E CANYON RIM RD
Mailing Address - Street 2:STE 103A
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92807-4313
Mailing Address - Country:US
Mailing Address - Phone:714-974-8130
Mailing Address - Fax:714-974-6811
Practice Address - Street 1:6200 E CANYON RIM RD
Practice Address - Street 2:STE 103A
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92807-4313
Practice Address - Country:US
Practice Address - Phone:714-974-8130
Practice Address - Fax:714-974-6811
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-26
Last Update Date:2017-04-27
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Provider Licenses
StateLicense IDTaxonomies
CAG44205207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA49582Medicare UPIN