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NPI Code Detail

MEDICARE: HARVEY CHUNG-DER CHANG M.D.

MEDICARE: HARVEY CHUNG-DER 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
1207ZC0500XCytopathology PhysicianC50076CA
2207ZP0102XAnatomic Pathology & Clinical Pathology PhysicianC50076CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P00037347OTHERCARAILROAD
251897OTHERMALICENSE
3C50076OTHERCALICENSE

General Provider Information

NPI Number : 1629074810
Entity Type Code : Individual
Provider Name (Legal Business Name) : HARVEY CHUNG-DER CHANG M.D.
Provider Business Mailing Address
First Line : PO BOX 576768
Second Line :
City : MODESTO
State : CA
Zip : 95357-6768
Country : US
Telephone Number : 209-577-1200
Fax Number : 209-577-6517
Provider Business Practice Location Address
First Line : 4301 N STAR WAY
Second Line :
City : MODESTO
State : CA
Zip : 95356-9262
Country : US
Telephone Number : 209-577-1200
Fax Number : 209-577-6517
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/22/2005
Last Update Date : 02/19/2025

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