MEDICARE: SHENG H. CHANG, M.D., INC.

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	261Q00000X	Clinic/Center	A 33409	CA

General Provider Information

NPI Number	:	1679804728
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHENG H. CHANG, M.D., INC.

Provider Business Mailing Address
First Line	:	330 W LAS TUNAS DR
Second Line	:	SUITE 3
City	:	SAN GABRIEL
State	:	CA
Zip	:	91776-1213
Country	:	US
Telephone Number	:	626-573-0055
Fax Number	:	626-573-4087

Provider Business Practice Location Address
First Line	:	330 W LAS TUNAS DR
Second Line	:	SUITE 3
City	:	SAN GABRIEL
State	:	CA
Zip	:	91776-1213
Country	:	US
Telephone Number	:	626-573-0055
Fax Number	:	626-573-4087

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SHENG H. CHANG
Credential	:	M.D.
Telephone Number	:	626-573-0055

Provider Enumeration Date	:	01/28/2010
Last Update Date	:	01/28/2010

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