Healthcare Provider Details

I. General information

NPI: 1346565280
Provider Name (Legal Business Name): GEORGE CHANG CHIEN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2010
Last Update Date: 12/05/2024
Certification Date: 12/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 W SANTA CLARA ST
VENTURA CA
93001-2543
US

IV. Provider business mailing address

1038 LOMA LISA LN
ARCADIA CA
91006-2218
US

V. Phone/Fax

Practice location:
  • Phone: 805-641-5600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number20A14068
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number20A14068
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number20A14068
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: