Provider Demographics
NPI:1922291020
Name:CHANG, SAMANTHA A (DO)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:A
Last Name:CHANG
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 RESPONSE RD
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95815-4807
Mailing Address - Country:US
Mailing Address - Phone:916-471-5035
Mailing Address - Fax:877-738-4262
Practice Address - Street 1:8170 LAGUNA BLVD
Practice Address - Street 2:#215
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-7901
Practice Address - Country:US
Practice Address - Phone:916-691-5900
Practice Address - Fax:916-691-6717
Is Sole Proprietor?:No
Enumeration Date:2007-08-22
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101017533207Q00000X
CA20A11351207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine