Provider Demographics
NPI:1215178728
Name:CHANG, CECIL (MD)
Entity Type:Individual
Prefix:DR
First Name:CECIL
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 1:3050 CITRUS CIR
Mailing Address - Street 2:#110
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-2698
Mailing Address - Country:US
Mailing Address - Phone:925-284-7873
Mailing Address - Fax:
Practice Address - Street 1:3050 CITRUS CIR
Practice Address - Street 2:#110
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-2698
Practice Address - Country:US
Practice Address - Phone:925-284-7873
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-12
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG21228208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics