Provider Demographics
NPI:1558471607
Name:CHANG, HENRY K (MD)
Entity type:Individual
Prefix:
First Name:HENRY
Middle Name:K
Last Name:CHANG
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3400 DATA DRIVE
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7956
Mailing Address - Country:US
Mailing Address - Phone:916-536-2484
Mailing Address - Fax:916-536-3541
Practice Address - Street 1:6555 COYLE AVENUE
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608
Practice Address - Country:US
Practice Address - Phone:916-536-2484
Practice Address - Fax:916-536-3541
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2012-03-20
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Provider Licenses
StateLicense IDTaxonomies
CAG23454207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA035164OtherHEALTH NET
CA14307OtherFIRST HEALTH
CA00G234540OtherBLUE SHIELD
CA00G234540Medicaid
CA4121OtherINTERPLAN
CA725811OtherUNITED
CA450181OtherGREAT WEST
CAG23454OtherBLUE CROSS
CA3702202OtherCIGNA
CA4507481OtherAETNA
CA90037762OtherPACIFICARE
CA000810342979OtherPHCS
CAMCMG123800OtherWESTERN HEALTH ADVANTAGE
CA450181OtherGREAT WEST
CA725811OtherUNITED