Provider Demographics
NPI:1235136243
Name:CHANG, DONG L (MD, INC)
Entity Type:Individual
Prefix:
First Name:DONG
Middle Name:L
Last Name:CHANG
Suffix:
Gender:M
Credentials:MD, INC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 N SANTA ANITA AVE
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-3108
Mailing Address - Country:US
Mailing Address - Phone:626-821-5998
Mailing Address - Fax:626-821-5990
Practice Address - Street 1:100 N SANTA ANITA AVE
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-3108
Practice Address - Country:US
Practice Address - Phone:626-821-5998
Practice Address - Fax:626-821-5990
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-05
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA33186207ND0101X, 207NS0135X, 207N00000X, 207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA27066Medicare UPIN