Healthcare Provider Details

I. General information

NPI: 1497277768
Provider Name (Legal Business Name): BRENT ALLEN CHANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2017
Last Update Date: 07/21/2022
Certification Date: 06/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5777 E MAYO BLVD DEPT OF
PHOENIX AZ
85054-4502
US

IV. Provider business mailing address

13400 E SHEA BLVD
SCOTTSDALE AZ
85259-5499
US

V. Phone/Fax

Practice location:
  • Phone: 480-628-0809
  • Fax:
Mailing address:
  • Phone: 480-301-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number53678
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: