Provider Demographics
NPI:1598826745
Name:CHANG, CAROLYN CHIENG LIN (MD)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:CHIENG LIN
Last Name:CHANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 WEBSTER STREET
Mailing Address - Street 2:SUITE 506
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-2374
Mailing Address - Country:US
Mailing Address - Phone:415-923-3067
Mailing Address - Fax:415-346-5019
Practice Address - Street 1:2100 WEBSTER STREET
Practice Address - Street 2:SUITE 506
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-2374
Practice Address - Country:US
Practice Address - Phone:415-923-3067
Practice Address - Fax:415-346-5019
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA545462086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
H55575Medicare UPIN
00A545460Medicare ID - Type Unspecified