Provider Demographics
NPI:1396857181
Name:CHANG, ALVIN (MD)
Entity Type:Individual
Prefix:DR
First Name:ALVIN
Middle Name:
Last Name:CHANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1101 BRYAN AVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-4401
Mailing Address - Country:US
Mailing Address - Phone:714-352-5800
Mailing Address - Fax:714-352-5801
Practice Address - Street 1:1101 BRYAN AVE
Practice Address - Street 2:SUITE E
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-4401
Practice Address - Country:US
Practice Address - Phone:714-352-5800
Practice Address - Fax:714-352-5801
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA55330207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
W18492OtherMEDICARE GRP NUMBER
CA00A553300Medicaid
CA1699040170OtherOCSC GROUP NPI
CADT9847OtherOCSC GROUP PTAN
G84968Medicare UPIN
CADT9847OtherOCSC GROUP PTAN