Healthcare Provider Details

I. General information

NPI: 1528046430
Provider Name (Legal Business Name): LAWRENCE CHUNG-LUN CHANG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

665 CAMINO DE LOS MARES SUITE 301
SAN CLEMENTE CA
92673-2859
US

IV. Provider business mailing address

665 CAMINO DE LOS MARES SUITE 301
SAN CLEMENTE CA
92673-2859
US

V. Phone/Fax

Practice location:
  • Phone: 949-240-9664
  • Fax: 949-240-0327
Mailing address:
  • Phone: 949-240-9664
  • Fax: 949-240-0327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA54221
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: