Healthcare Provider Details

I. General information

NPI: 1073572426
Provider Name (Legal Business Name): TERESA J. CHANG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2006
Last Update Date: 12/19/2024
Certification Date: 12/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 VIA JUANA RD
SANTA YNEZ CA
93460-9679
US

IV. Provider business mailing address

90 VIA JUANA RD
SANTA YNEZ CA
93460-9679
US

V. Phone/Fax

Practice location:
  • Phone: 805-688-7070
  • Fax: 805-686-2060
Mailing address:
  • Phone: 805-688-7070
  • Fax: 805-686-2060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number221112
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC167310
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: