Healthcare Provider Details

I. General information

NPI: 1699478800
Provider Name (Legal Business Name): ADAM JIA-XIANG CHANG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2023
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 CALHOUN ST
CHARLESTON SC
29401-1125
US

IV. Provider business mailing address

300 COMMUNITY DR STE 4DSU
MANHASSET NY
11030-3876
US

V. Phone/Fax

Practice location:
  • Phone: 843-724-2450
  • Fax: 843-724-2455
Mailing address:
  • Phone: 516-562-0100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number96657
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: