Healthcare Provider Details

I. General information

NPI: 1477189496
Provider Name (Legal Business Name): BRYSTON CHANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2020
Last Update Date: 08/14/2025
Certification Date: 08/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 S MAIN ST STE 525
ORANGE CA
92868-4553
US

IV. Provider business mailing address

505 S MAIN ST STE 525
ORANGE CA
92868-4553
US

V. Phone/Fax

Practice location:
  • Phone: 714-456-5631
  • Fax: 714-285-0389
Mailing address:
  • Phone: 714-456-5631
  • Fax: 714-285-0389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA185510
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: