Basic Information
| Provider Information | |||||||||
| NPI: | 1598704827 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHANG | ||||||||
| FirstName: | JOHN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 27401 LOS ALTOS | ||||||||
| Address2: | 180 | ||||||||
| City: | MISSION VIEJO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926916316 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9495829624 | ||||||||
| FaxNumber: | 9495829626 | ||||||||
| Practice Location | |||||||||
| Address1: | 27401 LOS ALTOS | ||||||||
| Address2: | 180 | ||||||||
| City: | MISSION VIEJO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926916316 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9495829624 | ||||||||
| FaxNumber: | 9495829626 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2006 | ||||||||
| LastUpdateDate: | 02/12/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | A65638 | CA | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 00A656380 | 05 | CA | MEDICAID |