Healthcare Provider Details

I. General information

NPI: 1508144783
Provider Name (Legal Business Name): GRACE CHANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2011
Last Update Date: 05/27/2025
Certification Date: 01/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 SANTA MONICA BLVD STE 560W
SANTA MONICA CA
90404-2208
US

IV. Provider business mailing address

1000 W CARSON ST # 400
TORRANCE CA
90502-2004
US

V. Phone/Fax

Practice location:
  • Phone: 310-453-5654
  • Fax: 310-453-6885
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberA123034
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: