Healthcare Provider Details

I. General information

NPI: 1316294994
Provider Name (Legal Business Name): MARIA CHANG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2012
Last Update Date: 08/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 S BASCOM AVE
SAN JOSE CA
95128
US

IV. Provider business mailing address

PO BOX 226
MENLO PARK CA
94026-0226
US

V. Phone/Fax

Practice location:
  • Phone: 408-885-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA130242
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License NumberA130242
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: