Provider Demographics
NPI:1609832724
Name:CHANG, KENNETH H (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:H
Last Name:CHANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:728 PACIFIC AVE
Mailing Address - Street 2:SUITE 402
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94133-4449
Mailing Address - Country:US
Mailing Address - Phone:415-421-4525
Mailing Address - Fax:415-421-4527
Practice Address - Street 1:728 PACIFIC AVE
Practice Address - Street 2:SUITE 402
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94133-4449
Practice Address - Country:US
Practice Address - Phone:415-421-4525
Practice Address - Fax:415-421-4527
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA55424207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A554240Medicaid
CA00A554240Medicaid
G47073Medicare UPIN