Provider Demographics
NPI:1871589903
Name:CHANG, SHENG H (MD)
Entity type:Individual
Prefix:
First Name:SHENG
Middle Name:H
Last Name:CHANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 W LAS TUNAS DR
Mailing Address - Street 2:SUITE 3
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776-1213
Mailing Address - Country:US
Mailing Address - Phone:626-573-0055
Mailing Address - Fax:626-573-4087
Practice Address - Street 1:330 W LAS TUNAS DR
Practice Address - Street 2:SUITE 3
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-1213
Practice Address - Country:US
Practice Address - Phone:626-573-0055
Practice Address - Fax:626-573-4087
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-23
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA33409207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A334090Medicaid
WA33409AMedicare ID - Type Unspecified
CA00A334090Medicaid