Healthcare Provider Details

I. General information

NPI: 1578609830
Provider Name (Legal Business Name): KEVIN J CHANG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 W IRONWOOD DR STE 378
COEUR D ALENE ID
83814-4401
US

IV. Provider business mailing address

700 W IRONWOOD DR STE 378
COEUR D ALENE ID
83814-4401
US

V. Phone/Fax

Practice location:
  • Phone: 208-625-3555
  • Fax: 208-769-8616
Mailing address:
  • Phone: 86-253-5552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberM9397
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: