MEDICARE: PEN-LAING CHANG MD

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	2080N0001X	Neonatal-Perinatal Medicine Physician	A44876	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	:	1457358897
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PEN-LAING CHANG MD

Provider Business Mailing Address
First Line	:	6339 DAYLILY CT
Second Line	:
City	:	RANCHO CUCAMONGA
State	:	CA
Zip	:	91737-3658
Country	:	US
Telephone Number	:	909-989-3875
Fax Number	:

Provider Business Practice Location Address
First Line	:	6339 DAYLILY CT
Second Line	:
City	:	RANCHO CUCAMONGA
State	:	CA
Zip	:	91737-3658
Country	:	US
Telephone Number	:	909-989-3875
Fax Number	:

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

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	05/12/2008

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Directions to “ PEN-LAING CHANG MD” Practice Location

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