Provider Demographics
NPI:1831358332
Name:CHANG, TARA KARI (MD)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:KARI
Last Name:CHANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2665 SCRIPTURE ST
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201-2302
Mailing Address - Country:US
Mailing Address - Phone:940-387-8763
Mailing Address - Fax:940-387-8889
Practice Address - Street 1:2665 SCRIPTURE ST
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-2302
Practice Address - Country:US
Practice Address - Phone:940-387-8763
Practice Address - Fax:940-387-8889
Is Sole Proprietor?:No
Enumeration Date:2008-06-09
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN9438207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00981929OtherMEDICARE RAILROAD
TX285401002Medicaid
TX372250YL7AOtherMEDICARE - OTHER COUNTY
TX285401001Medicaid
TX285401003OtherMEDICAID - OTHER COUNTY
TX285401003OtherMEDICAID - OTHER COUNTY