| Tae Yong Chang, | |
|
565 Snelling Ave S, Saint Paul, MN 55116-1525 | |
| (651) 698-0386 | |
| (866) 314-4031 |
| Full Name | Tae Yong Chang |
|---|---|
| Gender | Male |
| Speciality | Allergy & Immunology - Allergy |
| Location | 565 Snelling Ave S, Saint Paul, Minnesota |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467959619 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207KA0200X | Allergy & Immunology - Allergy | 78259 (Minnesota) | Primary |
| Entity Name | Southern California Permanente Medical Group |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1770515280 PECOS PAC ID: 6002729175 Enrollment ID: O20031110000678 |
| Mailing Address | Practice Location Address |
|---|---|
| Tae Yong Chang, 565 Snelling Ave S, Saint Paul, MN 55116-1525 Ph: (651) 698-0386 | Tae Yong Chang, 565 Snelling Ave S, Saint Paul, MN 55116-1525 Ph: (651) 698-0386 |
John Geoffrey Wahlstrom, M.D. Allergy & Immunology Medicare: Not Enrolled in Medicare Practice Location: 565 Snelling Ave S, Saint Paul, MN 55116 Phone: 651-698-0386 Fax: 651-698-0483 | |
Anthony Charles Orecchia, M.D. Allergy & Immunology Medicare: Not Enrolled in Medicare Practice Location: 1020 Bandana Blvd W, Saint Paul, MN 55108 Phone: 651-241-9700 | |
Dr. Niladri Aichbhaumik, MD Allergy & Immunology Medicare: Accepting Medicare Assignments Practice Location: 565 Snelling Ave S, Saint Paul, MN 55116 Phone: 651-698-0386 Fax: 651-698-0483 | |
Dr. Sarah Margaret Nicolai, M.D. Allergy & Immunology Medicare: Accepting Medicare Assignments Practice Location: 401 Phalen Blvd, Saint Paul, MN 55130 Phone: 651-254-7560 Fax: 651-254-7564 | |
Roula Altisheh, M.D Allergy & Immunology Medicare: Accepting Medicare Assignments Practice Location: 401 Phalen Blvd, Saint Paul, MN 55130 Phone: 651-254-7560 | |
William Emmett Walsh, M.D. Allergy & Immunology Medicare: Not Enrolled in Medicare Practice Location: 1690 University Ave W, Suite 450, Saint Paul, MN 55104 Phone: 651-645-8182 Fax: 651-649-3509 |