Healthcare Provider Details

I. General information

NPI: 1144217878
Provider Name (Legal Business Name): MICHAEL S CHANG OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 01/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17801 PIONEER BLVD SUITE F
ARTESIA CA
90701-3962
US

IV. Provider business mailing address

17801 PIONEER BLVD SUITE F
ARTESIA CA
90701-3962
US

V. Phone/Fax

Practice location:
  • Phone: 562-467-0813
  • Fax: 562-467-0816
Mailing address:
  • Phone: 562-467-0813
  • Fax: 562-467-0816

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number11341T
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: