Healthcare Provider Details

I. General information

NPI: 1659932549
Provider Name (Legal Business Name): CAROL CHANG DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2019
Last Update Date: 08/06/2024
Certification Date: 08/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 STATE ST
SALEM OR
97301-4257
US

IV. Provider business mailing address

1600 STATE ST
SALEM OR
97301-4257
US

V. Phone/Fax

Practice location:
  • Phone: 503-540-6300
  • Fax:
Mailing address:
  • Phone: 503-540-6300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License NumberDO220210
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number125.075184
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: