Healthcare Provider Details

I. General information

NPI: 1730689340
Provider Name (Legal Business Name): AIMEE C. CHANG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2018
Last Update Date: 06/20/2024
Certification Date: 06/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 GREEN VALLEY RD STE 202
FREEDOM CA
95019-3160
US

IV. Provider business mailing address

243 CHARLES ST
BOSTON MA
02114-3096
US

V. Phone/Fax

Practice location:
  • Phone: 831-728-2020
  • Fax:
Mailing address:
  • Phone: 617-573-3689
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number291480
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207WX0009X
TaxonomyGlaucoma Specialist (Ophthalmology) Physician
License NumberA165520
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: