Provider Demographics
NPI:1003808494
Name:CHANG, ANDREW (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:
Last Name:CHANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:18350 ROSCOE BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325-4109
Mailing Address - Country:US
Mailing Address - Phone:818-349-8300
Mailing Address - Fax:818-349-2214
Practice Address - Street 1:18350 ROSCOE BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-4109
Practice Address - Country:US
Practice Address - Phone:818-349-8300
Practice Address - Fax:818-349-2214
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-22
Last Update Date:2008-04-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG61183207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE37623Medicare UPIN
0760250001Medicare NSC