Provider Demographics
NPI:1265453724
Name:CHANG, DAVID W (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:W
Last Name:CHANG
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2512 SAMARITAN CT
Mailing Address - Street 2:SUITE E
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-4002
Mailing Address - Country:US
Mailing Address - Phone:408-358-8272
Mailing Address - Fax:408-356-7779
Practice Address - Street 1:2512 SAMARITAN CT
Practice Address - Street 2:SUITE E
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-4002
Practice Address - Country:US
Practice Address - Phone:408-358-8272
Practice Address - Fax:408-356-7779
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG742572086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA770002805OtherRAILROAD MEDICARE PIN
CA770002805OtherRAILROAD MEDICARE PIN
CAH12190Medicare UPIN