Healthcare Provider Details

I. General information

NPI: 1295077964
Provider Name (Legal Business Name): SHU CHEONG CHANG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2013
Last Update Date: 08/02/2021
Certification Date: 08/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 N NEVADA AVE STE 4007
COLORADO SPRINGS CO
80907-6863
US

IV. Provider business mailing address

2505 2ND AVE SUITE 200
SEATTLE WA
98121-1452
US

V. Phone/Fax

Practice location:
  • Phone: 719-776-8500
  • Fax: 719-776-4593
Mailing address:
  • Phone: 206-433-0400
  • Fax: 206-520-1599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberCDRH.0061783
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberCDRH.0061783
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: