Provider Demographics
NPI:1174598239
Name:CHANG, STEVEN DAVID (MD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:DAVID
Last Name:CHANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3160 TELEGRAPH RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-3233
Mailing Address - Country:US
Mailing Address - Phone:805-644-7312
Mailing Address - Fax:805-644-1584
Practice Address - Street 1:3160 TELEGRAPH RD
Practice Address - Street 2:SUITE 102
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-3233
Practice Address - Country:US
Practice Address - Phone:805-644-7312
Practice Address - Fax:805-644-1584
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-22
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG79197207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G791970Medicaid
CAW15452Medicare ID - Type Unspecified
CA00G791970Medicaid