DR. WALLACE HAN JEN CHANG (NPI# 1023165768) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1023165768 |
| Entity Type | Individual |
| Full Name | DR. WALLACE HAN JEN CHANG |
| Credential | M.D. |
| Practice Address |
17930 Talbot Rd S Renton WA 98055-6230 |
| Mailing Address |
805 Madison St Suite 901 Seattle WA 98104-1172 |
| Practice Telephone | 4252283187 |
| Practice Fax Number | 4252287972 |
| Mailing Telephone | 2062648100 |
| Enumeration Date | 2007-01-04 |
| Last Update Date | 2016-05-02 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 208200000X | Plastic Surgery | MD00019791 | WA | Allopathic & Osteopathic Physicians |
| N | 2082S0105X |
Plastic Surgery Specialization: Surgery of the Hand |
MD00019791 | WA | Allopathic & Osteopathic Physicians |
| Y | 2086S0122X |
Surgery Specialization: Plastic and Reconstructive Surgery |
MD00019791 | WA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WA | 1896307 | 05 | |
| L&I | 18213 | 01 |
| Street Address |
17930 TALBOT RD S |
| City | RENTON |
| State | WA |
| Zip Code | 98055-6230 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841347572 | David Teter Barker | Plastic Surgery | 17930 Talbot Rd S, Renton, WA 98055-6230 | 2007-01-04 |
| 1841610169 | Proliance Surgeons, Inc., P.s. | Plastic Surgery | 17930 Talbot Rd S, Renton, WA 98055-6230 | 2014-04-25 |
| 1306263322 | Trenton Matthew Morton | Plastic Surgery | 17930 Talbot Rd S, Renton, WA 98055-6230 | 2014-03-27 |
| 1003179300 | Chad Michael Bailey | Plastic Surgery | 17930 Talbot Rd S, Renton, WA 98055 | 2012-06-21 |
| 1316109309 | Proliance Surgeons Inc Ps | Clinic/Center | 17930 Talbot Rd S, Renton, WA 98055-6230 | 2008-06-30 |
| 1861549479 | Patricia Ann Briscoe | Plastic Surgery | 17930 Talbot Rd S, Renton, WA 98055-6230 | 2007-01-04 |
| 1538216296 | Jonathan James Hutter | Plastic Surgery | 17930 Talbot Rd S, Renton, WA 98055-6230 | 2007-01-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356965750 | Proliance Surgery Center At Valley, LLC | Clinic/Center | 4009 Talbot Road S, Suite 200, Renton, WA 98055 | 2020-06-01 |
| 1851804959 | Talbot Rehabilitation Center, LLC | Skilled Nursing Facility | 4430 Talbot Road South, Renton, WA 98055 | 2017-11-10 |
| 1154878668 | Nelson Family Dentistry | Dentist | 19221 108th Ave Se Suite #2, Renton, WA 98055 | 2016-09-01 |
| 1598182990 | Annie Kyunga Ahn | Otolaryngology | 4033 Talbot Rd S Ste 540, Renton, WA 98055 | 2014-03-24 |
| 1376960138 | Madhuri Gordhan Patel | Registered Nurse | 3501 Mill Place South, Renton, WA 98055 | 2014-03-18 |
| 1912331042 | Karen Dohr | Pharmacist | 400 S. 43 Street, Renton, WA 98055 | 2013-08-26 |
| 1659637668 | Benjamin Reiss | Ophthalmology | 4300 Talbot Rd S Ste 300, Renton, WA 98055 | 2012-04-03 |
| 1205137940 | Duy Ai Quang Hoang | Pharmacist | 9431 S 196th Pl, Renton, WA 98055 | 2010-11-11 |
| 1972823664 | Erica L Ellzey | Physical Therapist | 18623 112th Ave Se, Renton, WA 98055 | 2010-06-04 |
| 1588984587 | Melissa A. Jordan | Nurse Anesthetist, Certified Registered | 4011 Talbot Rd., 5th Floor, Renton, WA 98055 | 2010-06-02 |
| Find all providers in zip 98055 | ||||
| Taxonomy Code | 2086S0122X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| Specialization | Plastic and Reconstructive Surgery |
| A surgeon who specializes in plastic and reconstructive surgery. |
| Notes: Source: National Uniform Claim Committee, 2009 [1/1/2010: definition added, source added] Additional Resources: A General Certificate is issued by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982079927 | John Richard Alger | Surgery | 2323 Crystal Springs Rd W, University Place, WA 98466-2822 | 2015-12-02 |
| 1558752741 | Cole Aesthetic Center | Surgery | 9800 Levin Rd Nw Ste 101, Silverdale, WA 98383-7849 | 2015-02-10 |
| 1730524596 | Christopher Michael Bates | Surgery | 31852 Pacific Coast Hwy Suite 401, Laguna Beach, WA 92651 | 2013-05-07 |
| 1538401534 | Sattler Plastic Surgery | Surgery | 6100 219th St Sw Ste 290, Mountlake Terrace, WA 98043-2222 | 2013-03-18 |
| 1265744585 | Thomas D Gant | Surgery | 9006 Ne 116th Pl, Kirkland, WA 98034-6115 | 2010-07-02 |
| 1497928691 | Gabriel Plastic Surgery, Ps | Surgery | 505 Ne 87th Ave Ste 250, Vancouver, WA 98664-1965 | 2008-04-08 |
| 1255481446 | John Anthony Adams | Surgery | 530 S Cowley St Ste 180, Spokane, WA 99202-1316 | 2007-01-11 |
| 1821154790 | Alexander Gougoutas | Surgery | 1560 N 115th St Ste 206, Seattle, WA 98133-8414 | 2006-12-28 |
| 1972694743 | Brian H. Windle | Surgery | 7630 115th Pl Ne, Kirkland, WA 98033-6737 | 2006-09-27 |
| 1417931007 | Todd Michael Willcox | Surgery | 11311 Bridgeport Way Sw Ste 309, Lakewood, WA 98499-3078 | 2005-12-06 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.