Provider Demographics
NPI:1649329178
Name:CHANG, KENT J (OD)
Entity type:Individual
Prefix:DR
First Name:KENT
Middle Name:J
Last Name:CHANG
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:8901 GARDEN GROVE BLVD
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92844-1213
Mailing Address - Country:US
Mailing Address - Phone:714-530-1001
Mailing Address - Fax:714-530-1289
Practice Address - Street 1:8901 GARDEN GROVE BLVD
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92844-1213
Practice Address - Country:US
Practice Address - Phone:714-530-1001
Practice Address - Fax:714-530-1289
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11616T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1649329178OtherNPI
CA1649329178OtherNPI
CAU93619Medicare UPIN
CAWOP11616AMedicare PIN