Provider Demographics
NPI:1629316732
Name:CHANG, KALAI CLARA (RPH)
Entity Type:Individual
Prefix:
First Name:KALAI
Middle Name:CLARA
Last Name:CHANG
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:168 OAKVALE RD
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94597-3420
Mailing Address - Country:US
Mailing Address - Phone:925-988-9168
Mailing Address - Fax:
Practice Address - Street 1:300 PULLMAN ST
Practice Address - Street 2:
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94551-9756
Practice Address - Country:US
Practice Address - Phone:925-294-7322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-24
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0460231835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA046023OtherRPH