Provider Demographics
NPI:1649308545
Name:CHAN, CHANG D (OD)
Entity type:Individual
Prefix:DR
First Name:CHANG
Middle Name:D
Last Name:CHAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:1029 JEFFERSON BLVD
Mailing Address - Street 2:STE. G
Mailing Address - City:WEST SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95691-3344
Mailing Address - Country:US
Mailing Address - Phone:916-371-3421
Mailing Address - Fax:916-371-3421
Practice Address - Street 1:1029 JEFFERSON BLVD
Practice Address - Street 2:STE. G
Practice Address - City:WEST SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95691-3344
Practice Address - Country:US
Practice Address - Phone:916-371-3421
Practice Address - Fax:916-371-3421
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA5641TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist