Provider Demographics
NPI:1477596831
Name:CHANG, RAYMOND J (MD)
Entity Type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:J
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 1:4307 FOXFORD WAY
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568-7819
Mailing Address - Country:US
Mailing Address - Phone:949-422-8170
Mailing Address - Fax:949-422-8171
Practice Address - Street 1:4307 FOXFORD WAY
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:CA
Practice Address - Zip Code:94568-7819
Practice Address - Country:US
Practice Address - Phone:949-422-8170
Practice Address - Fax:949-422-8171
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG72078174400000X, 207RC0000X, 207R00000X
CA33-0966615207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No174400000XOther Service ProvidersSpecialist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G720780Medicaid
CA00G720780Medicaid
CAW1869AMedicare PIN
CAG72078Medicare ID - Type Unspecified