Basic Information
Provider Information
NPI: 1487941654
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CHANG
FirstName: STEVEN
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: DPT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 5656
Address2: #201
City: SANTA BARBARA
State: CA
PostalCode: 931505656
CountryCode: US
TelephoneNumber: 8055655252
FaxNumber: 8055655250
Practice Location
Address1: 4341 PIEDMONT AVE
Address2: 201
City: OAKLAND
State: CA
PostalCode: 946114766
CountryCode: US
TelephoneNumber: 5105471630
FaxNumber: 5109231944
Other Information
ProviderEnumerationDate: 07/07/2011
LastUpdateDate: 06/30/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000X36360CAY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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