1629384557 NPI number — DR. ROBIN RAY-LONG CHANG PH.D.

Table of content: DR. ROBIN RAY-LONG CHANG PH.D. (NPI 1629384557)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629384557 NPI number — DR. ROBIN RAY-LONG CHANG PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHANG
Provider First Name:
ROBIN
Provider Middle Name:
RAY-LONG
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1629384557
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/30/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4800 MEMORIAL DR
Provider Second Line Business Mailing Address:
BLDG. 7, RM 1C107
Provider Business Mailing Address City Name:
WACO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76711-1329
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
254-297-3522
Provider Business Mailing Address Fax Number:
254-297-3396

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4800 MEMORIAL DR
Provider Second Line Business Practice Location Address:
BLDG. 7, RM 1C107
Provider Business Practice Location Address City Name:
WACO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76711-1329
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
254-297-3522
Provider Business Practice Location Address Fax Number:
254-297-3396
Provider Enumeration Date:
08/30/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  PSY - 1182 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1182 . This is a "HAWAII LICENSURE PSY - 1182" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com