Provider Demographics
NPI:1205213410
Name:CHANG, KAY-WON
Entity Type:Individual
Prefix:
First Name:KAY-WON
Middle Name:
Last Name:CHANG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 KEARNEY STREET
Mailing Address - Street 2:BUILDING 2, 1ST FLOOR
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4000 DUBLIN BLVD
Practice Address - Street 2:3RD FLOOR
Practice Address - City:DUBLIN
Practice Address - State:CA
Practice Address - Zip Code:94568
Practice Address - Country:US
Practice Address - Phone:510-498-2178
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-27
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA144085207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease