Healthcare Provider Details

I. General information

NPI: 1124664255
Provider Name (Legal Business Name): CATHERINE T CHANG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/25/2019
Last Update Date: 09/13/2023
Certification Date: 09/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 HOMESTEAD RD
SANTA CLARA CA
95051-5353
US

IV. Provider business mailing address

2700 HOMESTEAD RD
SANTA CLARA CA
95051-5353
US

V. Phone/Fax

Practice location:
  • Phone: 408-247-8700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number75558
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: