Provider Demographics
NPI:1568491827
Name:TOM S. CHANG M.D., INC.
Entity Type:Organization
Organization Name:TOM S. CHANG M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIDIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-568-8838
Mailing Address - Street 1:800 FAIRMOUNT AVE
Mailing Address - Street 2:SUITE 312
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-3150
Mailing Address - Country:US
Mailing Address - Phone:626-568-8838
Mailing Address - Fax:626-583-8838
Practice Address - Street 1:800 FAIRMOUNT AVE
Practice Address - Street 2:SUITE 312
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3150
Practice Address - Country:US
Practice Address - Phone:626-568-8838
Practice Address - Fax:626-583-8838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF83145Medicare UPIN
CAG96148Medicare UPIN