Healthcare Provider Details

I. General information

NPI: 1093200503
Provider Name (Legal Business Name): VICTOR CHANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2018
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2659 MISSION ST
SAN MARINO CA
91108-1639
US

IV. Provider business mailing address

2659 MISSION ST
SAN MARINO CA
91108-1639
US

V. Phone/Fax

Practice location:
  • Phone: 626-833-2511
  • Fax:
Mailing address:
  • Phone: 626-833-2511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberA195067
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: