Provider Demographics
NPI:1164459335
Name:CHANG, RUBY (MD)
Entity Type:Individual
Prefix:DR
First Name:RUBY
Middle Name:
Last Name:CHANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2125 OAK GROVE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-2536
Mailing Address - Country:US
Mailing Address - Phone:925-296-7150
Mailing Address - Fax:925-296-7171
Practice Address - Street 1:2125 OAK GROVE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-2536
Practice Address - Country:US
Practice Address - Phone:925-296-7150
Practice Address - Fax:925-296-7171
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA817162085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A8171614Medicare PIN
CA00A8171619Medicare PIN
CA00A817167Medicare PIN
CAH82700Medicare UPIN
CA00A8171613Medicare PIN
CA00A8171618Medicare PIN
CA00A8171612Medicare PIN
CA00A817168Medicare PIN
CA00A8171615Medicare PIN
CA00A8171620Medicare PIN
CA00A8171621Medicare PIN
CA00A817169Medicare PIN
CA00A8171610Medicare PIN
CA00A8171622Medicare PIN
CA00A817163Medicare PIN
CA00A817165Medicare PIN
CAP00133300Medicare PIN
CA00A8171611Medicare PIN
CA00A8171617Medicare PIN
CA00A817162Medicare PIN
CA00A817166Medicare PIN
CA00A817161Medicare PIN
CAP00197714Medicare PIN
CA00A8171616Medicare PIN