Healthcare Provider Details

I. General information

NPI: 1215178728
Provider Name (Legal Business Name): CECIL CHANG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2009
Last Update Date: 03/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3050 CITRUS CIR #110
WALNUT CREEK CA
94598-2698
US

IV. Provider business mailing address

3050 CITRUS CIR #110
WALNUT CREEK CA
94598-2698
US

V. Phone/Fax

Practice location:
  • Phone: 925-284-7873
  • Fax:
Mailing address:
  • Phone: 925-284-7873
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG21228
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: