Provider Demographics
NPI:1083674550
Name:CHANG, WARREN (MD)
Entity Type:Individual
Prefix:DR
First Name:WARREN
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 1:2149 E WARNER RD STE 102
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85284-3495
Mailing Address - Country:US
Mailing Address - Phone:480-393-0309
Mailing Address - Fax:480-610-6189
Practice Address - Street 1:1498 SOUTHGATE AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-4015
Practice Address - Country:US
Practice Address - Phone:650-755-4492
Practice Address - Fax:650-755-4466
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-27
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAG9500207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
00A695001OtherBLUE SHIELD
CA00A695000Medicaid
CA00A695000Medicaid
00A695001OtherBLUE SHIELD