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NPI Code Detail

MEDICARE: BEVERLY CHANG MD

MEDICARE:   BEVERLY  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
1207R00000XInternal Medicine PhysicianMD00040979WA
2207R00000XInternal Medicine Physician6620038-1205UT

General Provider Information

NPI Number : 1780600973
Entity Type Code : Individual
Provider Name (Legal Business Name) : BEVERLY CHANG MD
Provider Business Mailing Address
First Line : PO BOX 27128
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84127-0128
Country : US
Telephone Number : 801-464-7660
Fax Number : 801-464-7695
Provider Business Practice Location Address
First Line : 2000 S 900 E
Second Line :
City : SLC
State : UT
Zip : 84105-3208
Country : US
Telephone Number : 801-464-7660
Fax Number : 801-464-7695
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/14/2006
Last Update Date : 06/07/2011

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Directions to “ BEVERLY CHANG MD” Practice Location

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