Healthcare Provider Details

I. General information

NPI: 1730158239
Provider Name (Legal Business Name): ROGER CHANG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2006
Last Update Date: 10/21/2020
Certification Date: 10/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 E CHAPMAN AVE
ORANGE CA
92869
US

IV. Provider business mailing address

2501 E CHAPMAN AVE
ORANGE CA
92869-3204
US

V. Phone/Fax

Practice location:
  • Phone: 714-771-8000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberA81984
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: