Healthcare Provider Details

I. General information

NPI: 1750807764
Provider Name (Legal Business Name): CHRISTINE SANGMI CHANG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2017
Last Update Date: 12/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 OLD SAN FRANCISCO RD
SUNNYVALE CA
94086-6386
US

IV. Provider business mailing address

2350 W EL CAMINO REAL FL 2
MOUNTAIN VIEW CA
94040-6203
US

V. Phone/Fax

Practice location:
  • Phone: 408-730-4251
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA147446
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: