Basic Information
| Provider Information | |||||||||
| NPI: | 1003015462 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHANG | ||||||||
| FirstName: | CHUN | ||||||||
| MiddleName: | JOEY | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| 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 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/16/2007 | ||||||||
| LastUpdateDate: | 09/06/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/06/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | A106131 | CA | N | Allopathic & Osteopathic Physicians | Family Medicine | 208100000X | 22015 | MD | N | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | 207P00000X | A106131 | CA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.