Healthcare Provider Details

I. General information

NPI: 1972787174
Provider Name (Legal Business Name): TAMMY T CHANG M.D., PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/24/2007
Last Update Date: 12/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

513 PARNASSUS AVE S321
SAN FRANCISCO CA
94143-0470
US

IV. Provider business mailing address

513 PARNASSUS AVE S321
SAN FRANCISCO CA
94143-0470
US

V. Phone/Fax

Practice location:
  • Phone: 415-476-1239
  • Fax: 415-502-1259
Mailing address:
  • Phone: 415-476-1239
  • Fax: 415-502-1259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA90279
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: