Healthcare Provider Details

I. General information

NPI: 1790755569
Provider Name (Legal Business Name): ALBERT BEOMJIN CHANG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 01/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16300 SAND CANYON AVE SUITE 910
IRVINE CA
92618-3711
US

IV. Provider business mailing address

16300 SAND CANYON AVE SUITE 910
IRVINE CA
92618-3711
US

V. Phone/Fax

Practice location:
  • Phone: 949-585-9870
  • Fax: 949-585-9331
Mailing address:
  • Phone: 949-585-9870
  • Fax: 949-585-9331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA77997
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: