Individual provider Active NPI

Yong Soon Chang, PHARMD

  • Pharmacist
  • Perris, CA
National Provider Identifier
1053710616
Registry record updated Mar 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
76368 Issued in CA
Practice address
404 E 4TH St
Perris, CA 92570-2201
Phone
(217) 721-3435
NPI assigned
Aug 20, 2014
Last updated
Mar 17, 2018By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 17, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 18381 NV
Pharmacist 183500000X RP00007930 NM
Pharmacist 183500000X 55516 TX
Pharmacist 183500000X 76368 CA Primary

Addresses

Primary practice location

404 E 4TH St
Perris, CA 92570-2201

Mailing address

5450 Beach Blvd Ste 110
Buena Park, CA 90621-1277
Phone (217) 721-3435

Other practice location 1

1900 Bataan Memorial E
Las Cruces, NM 88011-6011
Phone (575) 522-8603

Other practice location 2

12873 Harbor Blvd Ste M3
Garden Grove, CA 92840-5848
Phone (217) 721-3435

Other practice location 3

5450 Beach Blvd Ste 110
Buena Park, CA 90621-1277
Phone (217) 721-3435

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Pharmacy

State licenses

LicenseStateTypeSpecialty
76368CAMDPharmacist
RP00007930NMMDPharmacist
55516TXMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Meds Envy Inc Past Accepting new patients
Meds Envy Inc Past Accepting new patients
Meds Envy, Inc. Past Accepting new patients

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1408492800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1053710616",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5450 BEACH BLVD STE 110",
            "city": "BUENA PARK",
            "state": "CA",
            "postal_code": "906211277",
            "telephone_number": "217-721-3435",
            "fax_number": "915-943-1577"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "404 E 4TH ST",
            "city": "PERRIS",
            "state": "CA",
            "postal_code": "925702201",
            "telephone_number": "217-721-3435"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1900 Bataan Memorial E",
            "address_purpose": "LOCATION",
            "city": "Las Cruces",
            "state": "NM",
            "postal_code": "880116011",
            "country_code": "US",
            "telephone_number": "575-522-8603",
            "fax_number": "575-522-3419",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "12873 Harbor Blvd Ste M3",
            "address_purpose": "LOCATION",
            "city": "Garden Grove",
            "state": "CA",
            "postal_code": "928405848",
            "country_code": "US",
            "telephone_number": "217-721-3435",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5450 Beach Blvd Ste 110",
            "address_purpose": "LOCATION",
            "city": "Buena Park",
            "state": "CA",
            "postal_code": "906211277",
            "country_code": "US",
            "telephone_number": "217-721-3435",
            "fax_number": "915-943-1577",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CHANG",
        "first_name": "YONG SOON",
        "credential": "PHARMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-08-20",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "NV",
            "license": "18381",
            "primary": false
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "NM",
            "license": "RP00007930",
            "primary": false
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "TX",
            "license": "55516",
            "primary": false
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "CA",
            "license": "76368",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Perris, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.