Healthcare Provider Details

I. General information

NPI: 1477548667
Provider Name (Legal Business Name): SHI-HWA WILLIAM CHANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2005
Last Update Date: 01/03/2024
Certification Date: 01/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12824 STOCKHOLM WAY
TRUCKEE CA
96161-6943
US

IV. Provider business mailing address

12824 STOCKHOLM WAY
TRUCKEE CA
96161-6943
US

V. Phone/Fax

Practice location:
  • Phone: 209-596-2266
  • Fax:
Mailing address:
  • Phone: 209-596-2266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberA48531
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number199170
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: