Provider Demographics
NPI:1982898102
Name:ALBERT J CHANG, MD INC
Entity Type:Organization
Organization Name:ALBERT J CHANG, MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:E
Authorized Official - Last Name:LAMOUREUX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-796-7803
Mailing Address - Street 1:10408 INDUSTRIAL CIR
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-4548
Mailing Address - Country:US
Mailing Address - Phone:909-796-0363
Mailing Address - Fax:909-796-0762
Practice Address - Street 1:10408 INDUSTRIAL CIR
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374-4548
Practice Address - Country:US
Practice Address - Phone:909-796-0363
Practice Address - Fax:909-796-0762
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-30
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA78996207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1790984805OtherPERSONAL NPI
CA00A789960Medicaid
CA00A789960Medicaid