Healthcare Provider Details

I. General information

NPI: 1477696730
Provider Name (Legal Business Name): LUKE H. CHANG, M.D., A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 04/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 W CALIFORNIA BLVD
PASADENA CA
91105-3010
US

IV. Provider business mailing address

225 S LAKE AVE 535
PASADENA CA
91101-3005
US

V. Phone/Fax

Practice location:
  • Phone: 626-397-5000
  • Fax: 626-397-2912
Mailing address:
  • Phone: 626-795-6596
  • Fax: 626-795-8247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA61749
License Number StateCA

VIII. Authorized Official

Name: DR. LUKE H. CHANG
Title or Position: PRESIDENT
Credential: M.D.
Phone: 818-547-9921