Healthcare Provider Details

I. General information

NPI: 1619151826
Provider Name (Legal Business Name): BRYAN CHANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/24/2007
Last Update Date: 03/13/2024
Certification Date: 03/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3330 LOMITA BLVD
TORRANCE CA
90505-5002
US

IV. Provider business mailing address

34 WILLIAMSBURG DR
ORANGE CT
06477-1230
US

V. Phone/Fax

Practice location:
  • Phone: 310-517-4750
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0203X
TaxonomyTherapeutic Radiology Physician
License Number390200000X
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: