Healthcare Provider Details

I. General information

NPI: 1619269107
Provider Name (Legal Business Name): CARL J. CHANG, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2011
Last Update Date: 05/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N SANTA ANITA AVE
ARCADIA CA
91006-3108
US

IV. Provider business mailing address

100 N SANTA ANITA AVE
ARCADIA CA
91006-3108
US

V. Phone/Fax

Practice location:
  • Phone: 626-821-5998
  • Fax: 626-821-5990
Mailing address:
  • Phone: 626-821-5998
  • Fax: 626-821-5990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA91493
License Number StateCA

VIII. Authorized Official

Name: DR. CARL J CHANG
Title or Position: PRESIDENT
Credential: M.D.
Phone: 626-821-5998