Provider Demographics
NPI:1821382730
Name:CHANG, SAN KUO (MD)
Entity Type:Individual
Prefix:DR
First Name:SAN
Middle Name:KUO
Last Name:CHANG
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1121 NW 64TH TERRRACE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605
Mailing Address - Country:US
Mailing Address - Phone:352-331-3583
Mailing Address - Fax:352-331-3669
Practice Address - Street 1:1121 NW 64TH TERRRACE
Practice Address - Street 2:SUITE 220
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605
Practice Address - Country:US
Practice Address - Phone:352-331-3583
Practice Address - Fax:352-331-3669
Is Sole Proprietor?:No
Enumeration Date:2011-06-08
Last Update Date:2015-08-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLTRN159772084P0800X
FLME1168302084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry