=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104816255
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BAYARD WON CHANG M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/28/2005
-----------------------------------------------------
Last Update Date | 01/25/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 500 UNIVERSITY AVE SUITE 111
-----------------------------------------------------
City | SACRAMENTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95825-6504
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-929-2526
-----------------------------------------------------
Fax | 916-929-6128
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 500 UNIVERSITY AVE SUITE 111
-----------------------------------------------------
City | SACRAMENTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95825-6504
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-929-2526
-----------------------------------------------------
Fax | 916-929-6128
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | G064347
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------