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General NPI Number Information
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NPI Number | 1659932549
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Entity Type | Individual
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Provider Name | CAROL CHANG DO
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Gender | Female
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Dates
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Enumeration Date | 06/22/2019
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Last Update Date | 08/06/2024
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Provider Practice Location Address
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Address Line | 1600 STATE ST
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City | SALEM
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State | OR
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Zip | 97301-4257
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Country | US
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Telephone | 503-540-6300
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Fax |
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Provider Business Mailing Address
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Address Line | 1600 STATE ST
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City | SALEM
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State | OR
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Zip | 97301-4257
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Country | US
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Telephone | 503-540-6300
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081S0010X
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Taxonomy Name | Sports Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | DO220210
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 125.075184
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License Number State | IL
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