Healthcare Provider Details

I. General information

NPI: 1740849066
Provider Name (Legal Business Name): DAVID SEA JONG CHANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2019
Last Update Date: 11/28/2023
Certification Date: 11/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91275 66TH STREET SUITE 500
MECCA CA
92254
US

IV. Provider business mailing address

852 E DANENBERG DR
EL CENTRO CA
92243-8517
US

V. Phone/Fax

Practice location:
  • Phone: 760-396-1249
  • Fax: 760-396-1253
Mailing address:
  • Phone: 760-344-9951
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA179367
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: