Healthcare Provider Details

I. General information

NPI: 1851684062
Provider Name (Legal Business Name): CATHERINE S. CHANG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2011
Last Update Date: 12/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

436 N BEDFORD DR STE 103
BEVERLY HILLS CA
90210-4323
US

IV. Provider business mailing address

436 N BEDFORD DR STE 103
BEVERLY HILLS CA
90210-4323
US

V. Phone/Fax

Practice location:
  • Phone: 310-278-8200
  • Fax: 310-278-8230
Mailing address:
  • Phone: 310-278-8200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberMT199700
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberMT199700
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberA156372
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: