Provider Demographics
NPI:1114048733
Name:CHANG, PRISCILLA S (MD, PHD)
Entity Type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:S
Last Name:CHANG
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:183 E 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-2341
Mailing Address - Country:US
Mailing Address - Phone:530-891-6244
Mailing Address - Fax:530-891-0134
Practice Address - Street 1:183 E 8TH AVE
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-2341
Practice Address - Country:US
Practice Address - Phone:530-891-6244
Practice Address - Fax:530-891-0134
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA108451207ZP0102X, 207ZH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZH0000XAllopathic & Osteopathic PhysiciansPathologyHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABW674ZMedicare PIN