Healthcare Provider Details

I. General information

NPI: 1871653196
Provider Name (Legal Business Name): JAMES C CHANG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 04/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7053 W CENTRAL AVE
TOLEDO OH
43617-1114
US

IV. Provider business mailing address

7053 W CENTRAL AVE
TOLEDO OH
43617-1114
US

V. Phone/Fax

Practice location:
  • Phone: 419-843-1370
  • Fax: 419-843-8402
Mailing address:
  • Phone: 419-843-1370
  • Fax: 419-843-8402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number35046488
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: