Healthcare Provider Details

I. General information

NPI: 1629093208
Provider Name (Legal Business Name): DAVID S. CHANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 01/13/2022
Certification Date: 01/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 CASTRO ST STE 410
SAN FRANCISCO CA
94114-1027
US

IV. Provider business mailing address

PO BOX 7464
SAN FRANCISCO CA
94120-7464
US

V. Phone/Fax

Practice location:
  • Phone: 415-565-6884
  • Fax: 415-872-6723
Mailing address:
  • Phone: 415-502-7648
  • Fax: 415-502-8175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberA68382
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: