MEDICARE: ANDREW LUKE 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	2085R0001X	Radiation Oncology Physician	29428	OK
2	2085R0001X	Radiation Oncology Physician	01064419A	IN
3	2085R0001X	Radiation Oncology Physician	85308	CA
4	2085R0001X	Radiation Oncology Physician	MC-148	GU

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255513859
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW LUKE CHANG M.D.

Provider Business Mailing Address
First Line	:	9730 SUMMERS RIDGE RD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92121-3101
Country	:	US
Telephone Number	:	858-549-7400
Fax Number	:

Provider Business Practice Location Address
First Line	:	9730 SUMMERS RIDGE RD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92121-3101
Country	:	US
Telephone Number	:	858-549-7400
Fax Number	:

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

Provider Enumeration Date	:	12/05/2007
Last Update Date	:	10/23/2025

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