Provider Demographics
NPI:1336157478
Name:CHANG, NANCY W (MD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:W
Last Name:CHANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2930 2ND AVE
Mailing Address - Street 2:#200
Mailing Address - City:MARINA
Mailing Address - State:CA
Mailing Address - Zip Code:93933-6244
Mailing Address - Country:US
Mailing Address - Phone:831-582-2100
Mailing Address - Fax:831-886-1529
Practice Address - Street 1:2930 2ND AVE
Practice Address - Street 2:#200
Practice Address - City:MARINA
Practice Address - State:CA
Practice Address - Zip Code:93933-6244
Practice Address - Country:US
Practice Address - Phone:831-582-2100
Practice Address - Fax:831-886-1529
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA62665207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A626650Medicaid
CAWA62665BMedicare ID - Type Unspecified
CAG69036Medicare UPIN