Basic Information
| Provider Information | |||||||||
| NPI: | 1770873804 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHANG | ||||||||
| FirstName: | SHURONG | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D., PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3301 C ST STE 1400 | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958163367 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9167346111 | ||||||||
| FaxNumber: | 9164425702 | ||||||||
| Practice Location | |||||||||
| Address1: | 3301 C ST STE 1300 | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958163370 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9167346111 | ||||||||
| FaxNumber: | 9164425702 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2011 | ||||||||
| LastUpdateDate: | 03/17/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | A122412 | CA | Y | Allopathic & Osteopathic Physicians | Dermatology |
No ID Information.