MEDICARE: SHERMAN OAKS CARDIOLOGY ASSOCIATES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ZZZ36337A	OTHER	CA	BLUE SHIELD PROVIDER NUMB
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043299654
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHERMAN OAKS CARDIOLOGY ASSOCIATES

Provider Business Mailing Address
First Line	:	4835 VAN NUYS BLVD
Second Line	:	SUITE 114
City	:	SHERMAN OAKS
State	:	CA
Zip	:	91403-2109
Country	:	US
Telephone Number	:	818-783-0800
Fax Number	:	818-783-0802

Provider Business Practice Location Address
First Line	:	4929 VAN NUYS BLVD
Second Line	:
City	:	SHERMAN OAKS
State	:	CA
Zip	:	91403-1702
Country	:	US
Telephone Number	:	818-907-4530
Fax Number	:	818-907-4530

Authorized Official
Title or Position	:	CHAIRMAN
Name	:	DR. ROGER CHANG ON
Credential	:	M.D.
Telephone Number	:	818-783-0800

Provider Enumeration Date	:	01/11/2006
Last Update Date	:	03/24/2008

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