MEDICARE: DR. ENOCH H CHANG M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2081S0010X	Sports Medicine (Physical Medicine & Rehabilitation) Physician	TMP 02914	WV
2	2081S0010X	Sports Medicine (Physical Medicine & Rehabilitation) Physician	A126071	CA

General Provider Information

NPI Number	:	1205128196
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ENOCH H CHANG M.D.

Provider Business Mailing Address
First Line	:	6719 ALVARADO RD STE 200
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92120-5256
Country	:	US
Telephone Number	:	619-229-3934
Fax Number	:	619-582-2860

Provider Business Practice Location Address
First Line	:	6719 ALVARADO RD STE 200
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92120-5256
Country	:	US
Telephone Number	:	619-229-3932
Fax Number	:	619-582-2860

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/10/2011
Last Update Date	:	05/03/2022

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