Provider Demographics
NPI:1871550939
Name:CHANG-SMITH, CHARLENE D (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLENE
Middle Name:D
Last Name:CHANG-SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 FAIRHILL DR
Mailing Address - Street 2:
Mailing Address - City:OROVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95966-9504
Mailing Address - Country:US
Mailing Address - Phone:530-538-8513
Mailing Address - Fax:
Practice Address - Street 1:2809 OLIVE HWY
Practice Address - Street 2:STE 250
Practice Address - City:OROVILLE
Practice Address - State:CA
Practice Address - Zip Code:95966-6131
Practice Address - Country:US
Practice Address - Phone:530-532-7650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA070256207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A702560Medicaid
CA00A702560Medicaid
CAH18837Medicare UPIN