Healthcare Provider Details

I. General information

NPI: 1215674551
Provider Name (Legal Business Name): HENRY CHANG DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2022
Last Update Date: 10/22/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 SANTA MONICA BLVD
SANTA MONICA CA
90404-2303
US

IV. Provider business mailing address

21 SANTA RIDA
IRVINE CA
92606-8874
US

V. Phone/Fax

Practice location:
  • Phone: 310-453-1324
  • Fax: 310-212-5921
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number20A21989
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number20A21989
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: