Healthcare Provider Details

I. General information

NPI: 1649219452
Provider Name (Legal Business Name): KEVIN Q CHANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: QING ZHANG MD

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 05/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 N ROSE AVE SUITE 320
OXNARD CA
93030-3790
US

IV. Provider business mailing address

1700 N ROSE AVE SUITE 320
OXNARD CA
93030-3790
US

V. Phone/Fax

Practice location:
  • Phone: 805-485-8709
  • Fax: 805-485-5521
Mailing address:
  • Phone: 805-485-8709
  • Fax: 805-485-5521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberA70604
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: