Healthcare Provider Details

I. General information

NPI: 1962944074
Provider Name (Legal Business Name): CHANG MEDICAL PARTNERS APC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2016
Last Update Date: 04/17/2021
Certification Date: 04/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

291 GARDEN DR
THOUSAND OAKS CA
91361-5086
US

IV. Provider business mailing address

291 GARDEN DR
THOUSAND OAKS CA
91361-5086
US

V. Phone/Fax

Practice location:
  • Phone: 909-268-6538
  • Fax:
Mailing address:
  • Phone: 909-268-6538
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License NumberA144238
License Number StateCA

VIII. Authorized Official

Name: DENNIS CHANG
Title or Position: PRESIDENT
Credential: MD
Phone: 909-268-6538