Healthcare Provider Details

I. General information

NPI: 1578514873
Provider Name (Legal Business Name): CHANG Y OAK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 02/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1006 US HIGHWAY 64 E
PLYMOUTH NC
27962-9216
US

IV. Provider business mailing address

PO BOX 707
PLYMOUTH NC
27962-0707
US

V. Phone/Fax

Practice location:
  • Phone: 252-793-7701
  • Fax: 252-793-7736
Mailing address:
  • Phone: 252-793-4135
  • Fax: 252-793-1530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number26966
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: