Healthcare Provider Details

I. General information

NPI: 1639261654
Provider Name (Legal Business Name): EMERY J CHANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 06/12/2025
Certification Date: 06/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 COWLES ST
FAIRBANKS AK
99701-5907
US

IV. Provider business mailing address

1650 COWLES ST
FAIRBANKS AK
99701-5907
US

V. Phone/Fax

Practice location:
  • Phone: 907-458-2652
  • Fax: 907-459-3542
Mailing address:
  • Phone: 907-458-2652
  • Fax: 907-459-3542

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD00038868
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number129116
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: