Healthcare Provider Details

I. General information

NPI: 1417981796
Provider Name (Legal Business Name): CHRISTOPHER HAN SHENG CHANG M.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 02/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 SAN PEDRO DR SE MEDICINE SERVICE, BOX 111
ALBUQUERQUE NM
87108-5153
US

IV. Provider business mailing address

10833 LE CONTE AVE DIVISION OF DIGESTIVE DISEASES, UCLA SCHOOL OF MEDICINE
LOS ANGELES CA
90095-1684
US

V. Phone/Fax

Practice location:
  • Phone: 505-265-1711
  • Fax: 505-256-2803
Mailing address:
  • Phone: 310-206-9053
  • Fax: 310-267-2774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberA62290
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD2015-0819
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: