Healthcare Provider Details

I. General information

NPI: 1245479385
Provider Name (Legal Business Name): DONG L CHANG M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2009
Last Update Date: 09/19/2023
Certification Date: 09/19/2023
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 TaxonomyN
Taxonomy Code207NI0002X
TaxonomyClinical & Laboratory Dermatological Immunology Physician
License NumberA33186A
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207NP0225X
TaxonomyPediatric Dermatology Physician
License NumberA33186A
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberA33186A
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA33186A
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberA33186A
License Number StateCA
# 6
Primary TaxonomyY
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License NumberA33186A
License Number StateCA

VIII. Authorized Official

Name: DR. DONG LIANG CHANG
Title or Position: M.D.
Credential: M.D., INC.
Phone: 626-821-5998