Provider Demographics
NPI:1174545909
Name:CHANG, CHING HAI (MD)
Entity type:Individual
Prefix:DR
First Name:CHING
Middle Name:HAI
Last Name:CHANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:CHING
Other - Middle Name:HAI
Other - Last Name:CHANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1812 SAN MIGUEL DR
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596
Mailing Address - Country:US
Mailing Address - Phone:925-944-9193
Mailing Address - Fax:925-944-0682
Practice Address - Street 1:1812 SAN MIGUEL DR
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596
Practice Address - Country:US
Practice Address - Phone:925-944-9193
Practice Address - Fax:925-944-0682
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA34364207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C03929Medicare UPIN
CA00A343640Medicare ID - Type Unspecified