Healthcare Provider Details

I. General information

NPI: 1366411548
Provider Name (Legal Business Name): GARY J. CHANG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 02/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 UPPER RAGSDALE DR
MONTEREY CA
93940-5730
US

IV. Provider business mailing address

PO BOX 3168
SALINAS CA
93912-3168
US

V. Phone/Fax

Practice location:
  • Phone: 831-648-7200
  • Fax: 831-648-7204
Mailing address:
  • Phone: 831-649-1000
  • Fax: 831-649-4966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberG48331
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: