Healthcare Provider Details

I. General information

NPI: 1518233808
Provider Name (Legal Business Name): ANGELA CHANG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANGELA LIN

II. Dates (important events)

Enumeration Date: 03/30/2012
Last Update Date: 01/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825 4TH ST
SAN FRANCISCO CA
94143-2350
US

IV. Provider business mailing address

336 28TH ST
SAN FRANCISCO CA
94131-2309
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-7337
  • Fax:
Mailing address:
  • Phone: 727-741-1244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA135218
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2080P0201X
TaxonomyPediatric Allergy/Immunology Physician
License NumberA135218
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: