Provider Demographics
NPI:1427029677
Name:CHANG, RUEY-KANG R (MD)
Entity Type:Individual
Prefix:
First Name:RUEY-KANG
Middle Name:R
Last Name:CHANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1360 VALLEY VISTA DR
Mailing Address - Street 2:STE 203
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-3953
Mailing Address - Country:US
Mailing Address - Phone:310-866-0709
Mailing Address - Fax:310-755-3108
Practice Address - Street 1:1360 VALLEY VISTA DR
Practice Address - Street 2:STE 203
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91765-3953
Practice Address - Country:US
Practice Address - Phone:310-866-0709
Practice Address - Fax:310-755-3108
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-27
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA533312080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWA53331AMedicare UPIN
CAG99537Medicare UPIN