=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871091595
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANGEL CHANG MD, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/28/2018
-----------------------------------------------------
Last Update Date | 10/24/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 555 E VALLEY PKWY
-----------------------------------------------------
City | ESCONDIDO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92025-3048
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-739-3000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4231 BALBOA AVE # 419
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92117-5504
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-880-3336
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | ANGEL CHANG
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 619-880-3336
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208100000X
-----------------------------------------------------
Taxonomy Name | Physical Medicine & Rehabilitation Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------