Provider Demographics
NPI:1275744195
Name:CHANG, BENJAMIN M (DO)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:M
Last Name:CHANG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1102 A ST UNIT 1102A
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98401-1178
Mailing Address - Country:US
Mailing Address - Phone:253-274-1668
Mailing Address - Fax:
Practice Address - Street 1:1102 A ST UNIT 1536
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98401-1210
Practice Address - Country:US
Practice Address - Phone:253-274-1668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM3979207L00000X, 207LP3000X
WAOP00002194207LP3000X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP3000XAllopathic & Osteopathic PhysiciansAnesthesiologyPediatric Anesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX196671505Medicaid
TX196671506OtherCSHCN
TXB140516Medicare PIN