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NPI Code Detail

MEDICARE: DR. SHURONG CHANG M.D., PH.D.

MEDICARE: DR. SHURONG CHANG M.D., PH.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
1207N00000XDermatology PhysicianA122412CA

General Provider Information

NPI Number : 1770873804
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SHURONG CHANG M.D., PH.D.
Provider Business Mailing Address
First Line : 3301 C ST STE 1400
Second Line :
City : SACRAMENTO
State : CA
Zip : 95816-3367
Country : US
Telephone Number : 916-734-6111
Fax Number : 916-442-5702
Provider Business Practice Location Address
First Line : 3301 C ST STE 1300
Second Line :
City : SACRAMENTO
State : CA
Zip : 95816-3370
Country : US
Telephone Number : 916-734-6111
Fax Number : 916-442-5702
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/11/2011
Last Update Date : 03/17/2014

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