Healthcare Provider Details

I. General information

NPI: 1235137514
Provider Name (Legal Business Name): HAO CHANG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 OAKFORD AVE
RICHWOOD WV
26261-1150
US

IV. Provider business mailing address

25 OAKFORD AVE
RICHWOOD WV
26261-1150
US

V. Phone/Fax

Practice location:
  • Phone: 304-846-2608
  • Fax: 304-846-2608
Mailing address:
  • Phone: 304-846-2608
  • Fax: 304-846-2608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number9980
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: