Provider Demographics
NPI:1508068156
Name:CHANG, BAO (MD)
Entity Type:Individual
Prefix:DR
First Name:BAO
Middle Name:
Last Name:CHANG
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1225 CRANE ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-4257
Mailing Address - Country:US
Mailing Address - Phone:650-321-8881
Mailing Address - Fax:650-324-8700
Practice Address - Street 1:1225 CRANE ST
Practice Address - Street 2:SUITE 203
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-4257
Practice Address - Country:US
Practice Address - Phone:650-321-8881
Practice Address - Fax:650-324-8700
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2023-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG0698452084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG069845OtherSTATE LICENSE
CABC2487785OtherDEA