Provider Demographics
NPI:1205031333
Name:STEVEN D CHANG MD INC
Entity type:Organization
Organization Name:STEVEN D CHANG MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-644-7312
Mailing Address - Street 1:3160 TELEGRAPH RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-3233
Mailing Address - Country:US
Mailing Address - Phone:805-644-7312
Mailing Address - Fax:805-644-1584
Practice Address - Street 1:3160 TELEGRAPH RD
Practice Address - Street 2:SUITE 102
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-3233
Practice Address - Country:US
Practice Address - Phone:805-644-7312
Practice Address - Fax:805-644-1584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-19
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G791970Medicaid
CAF87838Medicare UPIN
CAW15452Medicare PIN