Provider Demographics
NPI:1063479269
Name:CHANG, MIN-SHONG (MD)
Entity Type:Individual
Prefix:
First Name:MIN-SHONG
Middle Name:
Last Name:CHANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27171 CALAROGA AVE
Mailing Address - Street 2:SUITE 14
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94545-4344
Mailing Address - Country:US
Mailing Address - Phone:510-782-1972
Mailing Address - Fax:510-782-1973
Practice Address - Street 1:27171 CALAROGA AVE
Practice Address - Street 2:SUITE 14
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94545-4344
Practice Address - Country:US
Practice Address - Phone:510-782-1972
Practice Address - Fax:510-782-1973
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-01
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA37315207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A373150Medicaid
A28352Medicare UPIN
00A373150Medicare ID - Type Unspecified