Provider Demographics
NPI:1710993969
Name:CHANG, SAMMY L (MD)
Entity Type:Individual
Prefix:
First Name:SAMMY
Middle Name:L
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 1:5 COBBLELAKE CT
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95831-4319
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3160 FOLSOM BLVD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5219
Practice Address - Country:US
Practice Address - Phone:916-733-5336
Practice Address - Fax:916-733-5385
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG38900208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1061826OtherFIRST HEALTH
CA00G389000Medicaid
CA90026119OtherPACIFICARE
CA00081342555OtherPHCS
CA1089809OtherGREAT WEST
CA2183696OtherFIRST HEALTH
CA4136OtherINTERPLAN
CA799901OtherUNITED
CAG38900OtherBLU CROSS
CA3794938OtherCIGNA
CA00G389000OtherBLUE SHIELD
CA4467996OtherAETNA
CA502629OtherHEALTH NET
CAMCMG123900OtherWESTERN HEALTH ADVANTAGE
CA4136OtherINTERPLAN
CA799901OtherUNITED