Healthcare Provider Details

I. General information

NPI: 1124110549
Provider Name (Legal Business Name): INGRID CHANG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2006
Last Update Date: 10/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8410 DECATUR ST
WESTMINSTER CO
80031-3811
US

IV. Provider business mailing address

4891 INDEPENDENCE ST SUITE 120
WHEAT RIDGE CO
80033-6752
US

V. Phone/Fax

Practice location:
  • Phone: 303-430-7000
  • Fax: 303-430-1506
Mailing address:
  • Phone: 303-456-5495
  • Fax: 303-456-7490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberMD39231
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: