Provider Demographics
NPI:1619062189
Name:CHANG, TAI S (MD)
Entity Type:Individual
Prefix:
First Name:TAI
Middle Name:S
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 1:223 N. GARFIELD AVE.
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754-1700
Mailing Address - Country:US
Mailing Address - Phone:626-307-7435
Mailing Address - Fax:626-307-7481
Practice Address - Street 1:223 N. GARFIELD AVE.
Practice Address - Street 2:SUITE 202
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-1700
Practice Address - Country:US
Practice Address - Phone:626-307-7435
Practice Address - Fax:626-307-7481
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA33443207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA33443AMedicaid
CAA33443AMedicaid
A27155Medicare UPIN