Provider Demographics
NPI:1386635621
Name:CHANG, NANCY SS (MD)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:SS
Last Name:CHANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3142 VISTA WAY
Mailing Address - Street 2:STE 303
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-3619
Mailing Address - Country:US
Mailing Address - Phone:760-630-2655
Mailing Address - Fax:760-630-3542
Practice Address - Street 1:3142 VISTA WAY
Practice Address - Street 2:STE 100
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-3619
Practice Address - Country:US
Practice Address - Phone:760-721-3200
Practice Address - Fax:760-754-3855
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA40339207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA88523Medicare UPIN
CAW11117Medicare ID - Type Unspecified