Provider Demographics
NPI:1902850555
Name:CHANGCHIEN, SCOTT CHICHEN (MD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:CHICHEN
Last Name:CHANGCHIEN
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 1:5855 OLIVAS PARK DR
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-7672
Mailing Address - Country:US
Mailing Address - Phone:805-667-2801
Mailing Address - Fax:805-667-2865
Practice Address - Street 1:3641 W 5TH ST
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-6424
Practice Address - Country:US
Practice Address - Phone:805-985-5505
Practice Address - Fax:805-984-6095
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC51871207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA050394OtherBLUE CROSS
CARHM08609FMedicaid
CARHM08608FMedicaid
CAZZT40394FMedicaid
CA951683892OtherOTHER INSURANCE
CARHM18553HMedicaid
CA058553Medicare ID - Type UnspecifiedRURAL HEALTH MEDICARE
CAWC51871CMedicare ID - Type UnspecifiedPPIN
CARHM18553HMedicaid
CARHM08609FMedicaid
CAWC51871FMedicare ID - Type UnspecifiedPPIN
CAWC51871BMedicare ID - Type UnspecifiedPPIN
CARHM08608FMedicaid
CAZZT40394FMedicaid
CA951683892OtherOTHER INSURANCE
CA050394OtherBLUE CROSS
CAWC51871DMedicare ID - Type UnspecifiedPPIN