MEDICARE: DR. ALVIN 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	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	A55330	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	W18492	OTHER		MEDICARE GRP NUMBER

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	1699040170	OTHER	CA	OCSC GROUP NPI
4	DT9847	OTHER	CA	OCSC GROUP PTAN

General Provider Information

NPI Number	:	1396857181
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALVIN CHANG M.D.

Provider Business Mailing Address
First Line	:	1101 BRYAN AVE
Second Line	:	SUITE E
City	:	TUSTIN
State	:	CA
Zip	:	92780-4401
Country	:	US
Telephone Number	:	714-352-5800
Fax Number	:	714-352-5801

Provider Business Practice Location Address
First Line	:	1101 BRYAN AVE
Second Line	:	SUITE E
City	:	TUSTIN
State	:	CA
Zip	:	92780-4401
Country	:	US
Telephone Number	:	714-352-5800
Fax Number	:	714-352-5801

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	09/19/2016

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Directions to “ DR. ALVIN CHANG M.D.” Practice Location

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