Basic Information
Provider Information
NPI: 1003015462
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CHANG
FirstName: CHUN
MiddleName: JOEY
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5255 NORMA WAY
Address2: #122
City: LIVERMORE
State: CA
PostalCode: 945503768
CountryCode: US
TelephoneNumber: 9259809126
FaxNumber:  
Practice Location
Address1: 401 PARADISE RD
Address2: #E
City: MODESTO
State: CA
PostalCode: 953513163
CountryCode: US
TelephoneNumber: 2095585107
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/16/2007
LastUpdateDate: 07/30/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000XA106131CAY Allopathic & Osteopathic PhysiciansFamily Medicine 
208100000X22015MDN Allopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation 

No ID Information.


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