Healthcare Provider Details

I. General information

NPI: 1558940254
Provider Name (Legal Business Name): MATTHEW CHANG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2021
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11370 ANDERSON ST # 1800
LOMA LINDA CA
92354-3450
US

IV. Provider business mailing address

11370 ANDERSON ST # 1800
LOMA LINDA CA
92354-3450
US

V. Phone/Fax

Practice location:
  • Phone: 909-558-2154
  • Fax:
Mailing address:
  • Phone: 909-558-2154
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberTLL-2025-002
License Number StateGU
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberA181703
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: