Healthcare Provider Details

I. General information

NPI: 1710993969
Provider Name (Legal Business Name): SAMMY L. CHANG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3160 FOLSOM BLVD
SACRAMENTO CA
95816-5219
US

IV. Provider business mailing address

5 COBBLELAKE CT
SACRAMENTO CA
95831-4319
US

V. Phone/Fax

Practice location:
  • Phone: 916-733-5336
  • Fax: 916-733-5385
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG38900
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: