Healthcare Provider Details

I. General information

NPI: 1447267141
Provider Name (Legal Business Name): WUN-LING CHANG, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 04/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9888 GENESEE AVE
LA JOLLA CA
92037-1205
US

IV. Provider business mailing address

3525 DEL MAR HEIGHTS RD # 453
SAN DIEGO CA
92130-2122
US

V. Phone/Fax

Practice location:
  • Phone: 858-202-1736
  • Fax: 858-202-1796
Mailing address:
  • Phone: 858-202-1736
  • Fax: 858-202-1796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberG86459
License Number StateCA

VIII. Authorized Official

Name: WUN-LING CHANG
Title or Position: PRESIDENT
Credential: M.D.
Phone: 858-202-1736