Provider Demographics
NPI:1366048688
Name:CHANG, YA-WEN (RD)
Entity type:Individual
Prefix:
First Name:YA-WEN
Middle Name:
Last Name:CHANG
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2089 155TH PL NE # C225
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98007-5072
Mailing Address - Country:US
Mailing Address - Phone:734-730-6243
Mailing Address - Fax:
Practice Address - Street 1:2089 155TH PL NE # C225
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98007-5072
Practice Address - Country:US
Practice Address - Phone:734-730-6243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-10
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered