Provider Demographics
NPI:1477548667
Name:CHANG, SHI-HWA WILLIAM (MD)
Entity Type:Individual
Prefix:
First Name:SHI-HWA
Middle Name:WILLIAM
Last Name:CHANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12824 STOCKHOLM WAY
Mailing Address - Street 2:
Mailing Address - City:TRUCKEE
Mailing Address - State:CA
Mailing Address - Zip Code:96161-6943
Mailing Address - Country:US
Mailing Address - Phone:209-596-2266
Mailing Address - Fax:
Practice Address - Street 1:12824 STOCKHOLM WAY
Practice Address - Street 2:
Practice Address - City:TRUCKEE
Practice Address - State:CA
Practice Address - Zip Code:96161-6943
Practice Address - Country:US
Practice Address - Phone:209-596-2266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA48531207W00000X
NY199170207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A485310Medicaid
NY01731795Medicaid
F49619Medicare UPIN
RA0484Medicare ID - Type Unspecified
NY01731795Medicaid