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General NPI Number Information
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NPI Number | 1578116075
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Entity Type | Organization
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Legal Business Name | GRACE C CHANG MEDICAL DOCTOR INC
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Dates
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Enumeration Date | 07/23/2019
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Last Update Date | 07/23/2019
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Provider Practice Location Address
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Address Line | 2080 CENTURY PARK E STE 1111
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City | LOS ANGELES
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State | CA
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Zip | 90067-2029
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Country | US
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Telephone | 310-842-4811
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 7001
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City | TARZANA
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State | CA
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Zip | 91357-7001
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Country | US
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Telephone | 818-888-7815
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Fax | 818-715-1722
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Authorized Official
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Title or Position | SOLE OWNER
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Name | GRACE C CHANG
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Credential | MD
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Telephone | 415-971-8788
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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