Healthcare Provider Details

I. General information

NPI: 1598853418
Provider Name (Legal Business Name): CHIU-AN CHANG D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 N TUCSON BLVD STE 12
TUCSON AZ
85716-3425
US

IV. Provider business mailing address

1601 N TUCSON BLVD STE 12
TUCSON AZ
85716-3425
US

V. Phone/Fax

Practice location:
  • Phone: 520-323-3056
  • Fax: 520-323-3057
Mailing address:
  • Phone: 520-323-3056
  • Fax: 520-323-3057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number2216
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: