Provider Demographics
NPI:1023051406
Name:CHANG, KENNETH (MD)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:
Last Name:CHANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:5730 EXECUTIVE DR STE 230
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-1762
Mailing Address - Country:US
Mailing Address - Phone:610-387-4520
Mailing Address - Fax:610-387-4526
Practice Address - Street 1:100 MARIS GROVE WAY
Practice Address - Street 2:
Practice Address - City:GLEN MILLS
Practice Address - State:PA
Practice Address - Zip Code:19342-1282
Practice Address - Country:US
Practice Address - Phone:610-387-4520
Practice Address - Fax:610-387-4526
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2023-08-28
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Provider Licenses
StateLicense IDTaxonomies
PAMD062908L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAH19873Medicare UPIN