MEDICARE: DR. CYNTHIA M CARSOLIN-CHANG M.D.

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	174400000X	Specialist	A48831	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235160409
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CYNTHIA M CARSOLIN-CHANG M.D.

Provider Business Mailing Address
First Line	:	1800 SULLIVAN AVE
Second Line	:	RM 506
City	:	DALY CITY
State	:	CA
Zip	:	94015-2225
Country	:	US
Telephone Number	:	415-642-5881
Fax Number	:	415-647-0841

Provider Business Practice Location Address
First Line	:	1800 SULLIVAN AVE
Second Line	:	RM 506
City	:	DALY CITY
State	:	CA
Zip	:	94015-2225
Country	:	US
Telephone Number	:	415-642-5881
Fax Number	:	415-647-0841

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	11/01/2017

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Directions to “ DR. CYNTHIA M CARSOLIN-CHANG M.D.” Practice Location

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