Healthcare Provider Details

I. General information

NPI: 1205196474
Provider Name (Legal Business Name): KUO HSIEN CHANG,MD.INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2012
Last Update Date: 05/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18391 COLIMA RD STE 202
ROWLAND HEIGHTS CA
91748-2730
US

IV. Provider business mailing address

18391 COLIMA RD STE 202
ROWLAND HEIGHTS CA
91748-2730
US

V. Phone/Fax

Practice location:
  • Phone: 626-965-0696
  • Fax: 626-965-0265
Mailing address:
  • Phone: 626-965-0696
  • Fax: 626-965-0265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number444-2883-7
License Number StateCA

VIII. Authorized Official

Name: KUO HSIEN CHANG
Title or Position: PRESIDENT
Credential: MD
Phone: 626-965-0696