Healthcare Provider Details

I. General information

NPI: 1295766889
Provider Name (Legal Business Name): DOUGLAS CHANG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26730 TOWNE CENTRE DR SUITE 202
FOOTHILL RANCH CA
92610-2842
US

IV. Provider business mailing address

26730 TOWNE CENTRE DR SUITE 202
FOOTHILL RANCH CA
92610-2842
US

V. Phone/Fax

Practice location:
  • Phone: 949-600-7887
  • Fax: 949-600-7889
Mailing address:
  • Phone: 949-600-7887
  • Fax: 949-600-7889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberG63764
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: