Healthcare Provider Details

I. General information

NPI: 1013003946
Provider Name (Legal Business Name): DAVID C CHANG, MD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 10/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 PLACENTIA AVE SUITE # 111
NEWPORT BEACH CA
92663-3310
US

IV. Provider business mailing address

PO BOX 61117
IRVINE CA
92602-6037
US

V. Phone/Fax

Practice location:
  • Phone: 949-722-1112
  • Fax: 949-631-6356
Mailing address:
  • Phone: 949-722-1112
  • Fax: 949-631-6356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA63440
License Number StateCA

VIII. Authorized Official

Name: MS. MARISOL L CHANG
Title or Position: ADMINISTRATOR
Credential: RN, BSN
Phone: 949-722-1112