Provider Demographics
NPI:1720053978
Name:CHANG, SOPHIE H (MD)
Entity Type:Individual
Prefix:
First Name:SOPHIE
Middle Name:H
Last Name:CHANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SOPHIE
Other - Middle Name:
Other - Last Name:CHANG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:5345 BAYRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:RANCHO PALOS VERDES
Mailing Address - State:CA
Mailing Address - Zip Code:90275-1711
Mailing Address - Country:US
Mailing Address - Phone:310-493-0080
Mailing Address - Fax:
Practice Address - Street 1:2509 PICO BLVD
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-1828
Practice Address - Country:US
Practice Address - Phone:310-392-8636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA055936207Q00000X
CAA55936207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1720053978OtherNPI