Individual
ETHAN CHANG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
7203 129TH AVE SE STE 100, NEWCASTLE, WA 98056-1412
(425) 690-3455
(425) 690-9455
Mailing address
3600 LIND AVE SW, SUITE 100 ATTN CREDENTIALING, RENTON, WA 98057-4970
(425) 690-2715
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
OP61311708
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2160428
—
WA
Enumeration date
03/16/2017
Last updated
09/15/2023
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