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General NPI Number Information
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NPI Number | 1447530076
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Entity Type | Organization
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Legal Business Name | KENNETH H CHANG MD A MEDICAL CORP
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Dates
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Enumeration Date | 08/26/2011
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Last Update Date | 10/26/2016
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Provider Practice Location Address
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Address Line | 728 PACIFIC AVE SUITE 402
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City | SAN FRANCISCO
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State | CA
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Zip | 94133-4457
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Country | US
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Telephone | 415-421-4525
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Fax | 415-421-4527
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Provider Business Mailing Address
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Address Line | 728 PACIFIC AVE SUITE 402
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City | SAN FRANCISCO
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State | CA
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Zip | 94133-4457
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Country | US
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Telephone | 415-421-4525
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Fax | 415-421-4527
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Authorized Official
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Title or Position | OWNER
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Name | DR. KENNETH H CHANG
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Credential | MD
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Telephone | 415-421-4525
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A55424
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License Number State | CA
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