Provider Demographics
NPI:1649219452
Name:CHANG, KEVIN Q (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:Q
Last Name:CHANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:QING
Other - Middle Name:
Other - Last Name:ZHANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1700 N ROSE AVE
Mailing Address - Street 2:SUITE 320
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93030-3790
Mailing Address - Country:US
Mailing Address - Phone:805-485-8709
Mailing Address - Fax:805-485-5521
Practice Address - Street 1:1700 N ROSE AVE
Practice Address - Street 2:SUITE 320
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-3790
Practice Address - Country:US
Practice Address - Phone:805-485-8709
Practice Address - Fax:805-485-5521
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2009-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA70604207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A706040Medicaid
P00301869OtherRAILROAD MEDICARE
CA5628497OtherNCPDP/NPDS
CA00A706040Medicaid
CA5628497OtherNCPDP/NPDS
WA70604AMedicare PIN