Provider Demographics
NPI:1669546651
Name:CHEN, TSUNG CHANG (MD)
Entity type:Individual
Prefix:DR
First Name:TSUNG CHANG
Middle Name:
Last Name:CHEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10430 S DE ANZA BLVD
Mailing Address - Street 2:E220
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-3019
Mailing Address - Country:US
Mailing Address - Phone:408-257-8860
Mailing Address - Fax:408-519-6556
Practice Address - Street 1:10430 S DE ANZA BLVD
Practice Address - Street 2:E220
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-3019
Practice Address - Country:US
Practice Address - Phone:408-257-8860
Practice Address - Fax:408-519-6556
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA45142207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A451420Medicaid
F43090Medicare UPIN
CA00A451420Medicaid