=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386667889
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOHN W CHANG M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/25/2006
-----------------------------------------------------
Last Update Date | 05/10/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 18351 BEACH BLVD STE. G
-----------------------------------------------------
City | HUNTINGTON BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92648-1345
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-847-0010
-----------------------------------------------------
Fax | 714-847-0017
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 251615
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90025-9243
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-850-5921
-----------------------------------------------------
Fax | 310-773-9262
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208100000X
-----------------------------------------------------
Taxonomy Name | Physical Medicine & Rehabilitation Physician
-----------------------------------------------------
License Number | A77448
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------