Provider Demographics
NPI:1053710616
Name:CHANG, YONG SOON (PHARMD)
Entity type:Individual
Prefix:
First Name:YONG SOON
Middle Name:
Last Name:CHANG
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5450 BEACH BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90621-1277
Mailing Address - Country:US
Mailing Address - Phone:217-721-3435
Mailing Address - Fax:915-943-1577
Practice Address - Street 1:404 E 4TH ST
Practice Address - Street 2:
Practice Address - City:PERRIS
Practice Address - State:CA
Practice Address - Zip Code:92570-2201
Practice Address - Country:US
Practice Address - Phone:217-721-3435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-20
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV18381183500000X
NMRP00007930183500000X
TX55516183500000X
CA76368183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist