Healthcare Provider Details

I. General information

NPI: 1588223382
Provider Name (Legal Business Name): BRIAN CHANG PHUNG DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2019
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 N JACKSON AVE STE 235
SAN JOSE CA
95116-1635
US

IV. Provider business mailing address

227 N JACKSON AVE STE 235
SAN JOSE CA
95116-1635
US

V. Phone/Fax

Practice location:
  • Phone: 408-254-9192
  • Fax: 408-254-9194
Mailing address:
  • Phone: 408-254-9192
  • Fax: 408-254-9194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number19656
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberLL82245
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: