Healthcare Provider Details

I. General information

NPI: 1922245349
Provider Name (Legal Business Name): SHADY CANYON MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2009
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15825 LAGUNA CANYON RD STE 104
IRVINE CA
92618-2126
US

IV. Provider business mailing address

15825 LAGUNA CANYON RD STE 104
IRVINE CA
92618-2126
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: DR. ALBERT BEOMJIN CHANG
Title or Position: MD/OWNER
Credential: M.D.
Phone: 949-585-9870