Provider Demographics
NPI:1164502258
Name:CHANG, GREGORY Y (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:Y
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 1:4860 Y ST STE 3700
Mailing Address - Street 2:UC DAVIS MEDICAL CENTER
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-2307
Mailing Address - Country:US
Mailing Address - Phone:916-734-6280
Mailing Address - Fax:916-734-6525
Practice Address - Street 1:4860 Y ST STE 3700
Practice Address - Street 2:UC DAVIS MEDICAL CENTER
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2307
Practice Address - Country:US
Practice Address - Phone:916-734-6280
Practice Address - Fax:916-734-6525
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG407442084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ550608Medicaid
AZ550608Medicaid