Healthcare Provider Details

I. General information

NPI: 1699790733
Provider Name (Legal Business Name): BELINDA CHANG HOLLAND M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHING-I BELINDA CHANG MD

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 07/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10180 SE SUNNYSIDE RD
CLACKAMAS OR
97015-8970
US

IV. Provider business mailing address

10180 SE SUNNYSIDE RD
CLACKAMAS OR
97015
US

V. Phone/Fax

Practice location:
  • Phone: 503-571-8656
  • Fax:
Mailing address:
  • Phone: 503-571-8656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA81607
License Number StateCA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier00A816070
Identifier TypeMEDICAID
Identifier StateCA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: