=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679827091
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FRANCIS CHANG MD INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/07/2012
-----------------------------------------------------
Last Update Date | 11/07/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 801 S FLOWER ST SUITE 204
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90017-4625
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-963-6984
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 801 S FLOWER ST SUITE 204
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90017-4625
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-963-6984
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MD/OWNER
-----------------------------------------------------
Name | FRANCIS CHANG
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 310-963-6984
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | A108404
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------