Provider Demographics
NPI:1598811796
Name:BAY AREA SPORTS ORTHOPAEDICS, INC
Entity Type:Organization
Organization Name:BAY AREA SPORTS ORTHOPAEDICS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:S
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-834-2276
Mailing Address - Street 1:1563 SOLANO AVE
Mailing Address - Street 2:SUITE 336
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94707-2116
Mailing Address - Country:US
Mailing Address - Phone:510-834-2276
Mailing Address - Fax:510-834-2202
Practice Address - Street 1:3300 WEBSTER ST
Practice Address - Street 2:SUITE 907
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3117
Practice Address - Country:US
Practice Address - Phone:510-834-2276
Practice Address - Fax:510-834-2202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-28
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA87115207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty