MEDICARE: DR. EDGAR JASON CHANG D.C.

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	111N00000X	Chiropractor	DC943	HI
2	111N00000X	Chiropractor	142065	TX
3	111N00000X	Chiropractor	DC28462	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DC28462	OTHER	CA	COMMERCIAL INSURERS

General Provider Information

NPI Number	:	1619935632
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDGAR JASON CHANG D.C.

Provider Business Mailing Address
First Line	:	190 E STACY RD STE 306-382
Second Line	:
City	:	ALLEN
State	:	TX
Zip	:	75002-8734
Country	:	US
Telephone Number	:	310-381-0024
Fax Number	:

Provider Business Practice Location Address
First Line	:	6888 LINCOLN AVE STE J2
Second Line	:
City	:	BUENA PARK
State	:	CA
Zip	:	90620-4107
Country	:	US
Telephone Number	:	714-828-2865
Fax Number	:

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

Provider Enumeration Date	:	05/01/2006
Last Update Date	:	04/24/2023

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Directions to “ DR. EDGAR JASON CHANG D.C.” Practice Location

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