Basic Information
| Provider Information | |||||||||
| NPI: | 1487873386 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHANG | ||||||||
| FirstName: | CHRISTINA | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 733784 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 753733784 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6828851855 | ||||||||
| FaxNumber: | 6828851396 | ||||||||
| Practice Location | |||||||||
| Address1: | 4300 W UNIVERSITY DR STE 10 | ||||||||
| Address2: | |||||||||
| City: | PROSPER | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750789806 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6823038050 | ||||||||
| FaxNumber: | 6823038052 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/25/2007 | ||||||||
| LastUpdateDate: | 05/18/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | P4940 | TX | Y | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 20A9308 | CA | N | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.