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General NPI Number Information
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NPI Number | 1750410262
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Entity Type | Individual
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Provider Name | CATHERINE KYONGA CHANG MD
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Gender | Female
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Dates
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Enumeration Date | 03/02/2007
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Last Update Date | 12/02/2021
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Provider Practice Location Address
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Address Line | 4647 ZION AVE
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City | SAN DIEGO
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State | CA
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Zip | 92120-2507
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Country | US
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Telephone | 619-528-7931
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Fax | 319-528-3777
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Provider Business Mailing Address
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Address Line | 4647 ZION AVE
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City | SAN DIEGO
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State | CA
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Zip | 92120-2507
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Country | US
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Telephone | 619-528-7931
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Fax | 319-528-3777
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | A79317
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | ME107331
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | A79317
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License Number State | CA
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