MEDICARE: KENNETH J 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	207RG0100X	Gastroenterology Physician	000000G61843	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	100014901	OTHER	CA	RR MEDICARE

General Provider Information

NPI Number	:	1518047604
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH J CHANG MD

Provider Business Mailing Address
First Line	:	500 SUPERIOR AVE STE 240
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92663-3660
Country	:	US
Telephone Number	:	949-764-8959
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 SUPERIOR AVE STE 240
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92663-3660
Country	:	US
Telephone Number	:	949-764-8959
Fax Number	:

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

Provider Enumeration Date	:	10/16/2006
Last Update Date	:	05/07/2026

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