Provider Demographics
NPI:1558565366
Name:CHANG, JAVIER F (MD)
Entity Type:Individual
Prefix:
First Name:JAVIER
Middle Name:F
Last Name:CHANG
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1601 MONTE VISTA AVE STE 260
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-6604
Mailing Address - Country:US
Mailing Address - Phone:909-865-9501
Mailing Address - Fax:909-469-4721
Practice Address - Street 1:1601 MONTE VISTA AVE STE 190
Practice Address - Street 2:
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711-6600
Practice Address - Country:US
Practice Address - Phone:909-865-9977
Practice Address - Fax:909-946-0166
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2018-11-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA86715207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI46865Medicare UPIN