Healthcare Provider Details

I. General information

NPI: 1265502793
Provider Name (Legal Business Name): TERRANCE T CHANG MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 11/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8723 SIERRA COLLEGE BLVD SUITE 220
ROSEVILLE CA
95661-5920
US

IV. Provider business mailing address

4120 DOUGLAS BLVD # 112
GRANITE BAY CA
95746-5936
US

V. Phone/Fax

Practice location:
  • Phone: 916-791-0797
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License NumberG33580
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG33580
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2080I0007X
TaxonomyPediatric Clinical & Laboratory Immunology Physician
License NumberG33580
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License NumberG33580
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code207KI0005X
TaxonomyClinical & Laboratory Immunology (Allergy & Immunology) Physician
License NumberG33580
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code2080P0201X
TaxonomyPediatric Allergy/Immunology Physician
License NumberG33580
License Number StateCA
# 7
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberG33580
License Number StateCA

VIII. Authorized Official

Name: TERRANCE T CHANG
Title or Position: PHYSICIAN
Credential:
Phone: 916-791-0797