Healthcare Provider Details

I. General information

NPI: 1215460712
Provider Name (Legal Business Name): ELBERT CHANG D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2017
Last Update Date: 01/24/2023
Certification Date: 01/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8077 FLORENCE AVE
DOWNEY CA
90240-3826
US

IV. Provider business mailing address

8077 FLORENCE AVE
DOWNEY CA
90240-3826
US

V. Phone/Fax

Practice location:
  • Phone: 562-904-6031
  • Fax:
Mailing address:
  • Phone: 562-904-6031
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number67503
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number20A20268
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: