Healthcare Provider Details

I. General information

NPI: 1285943589
Provider Name (Legal Business Name): CHARLES CHANG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2010
Last Update Date: 12/06/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W ARBOR DR MAIL CODE 8894
SAN DIEGO CA
92103-9000
US

IV. Provider business mailing address

200 W ARBOR DR MAIL CODE 8894
SAN DIEGO CA
92103-9000
US

V. Phone/Fax

Practice location:
  • Phone: 619-543-6312
  • Fax: 619-543-7480
Mailing address:
  • Phone: 619-543-6312
  • Fax: 619-543-7480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberA113431
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: