=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649681982
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HEIDI CHANG MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/08/2014
-----------------------------------------------------
Last Update Date | 11/13/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2637 SHADELANDS DR
-----------------------------------------------------
City | WALNUT CREEK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94598-2512
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-393-0033
-----------------------------------------------------
Fax | 925-301-8956
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2637 SHADELANDS DR
-----------------------------------------------------
City | WALNUT CREEK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94598-2512
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-393-0033
-----------------------------------------------------
Fax | 925-301-8956
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | A128445
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------