Provider Demographics
NPI:1104816255
Name:CHANG, BAYARD WON (MD)
Entity type:Individual
Prefix:DR
First Name:BAYARD
Middle Name:WON
Last Name:CHANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 UNIVERSITY AVE
Mailing Address - Street 2:SUITE 111
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-6504
Mailing Address - Country:US
Mailing Address - Phone:916-929-2526
Mailing Address - Fax:916-929-6128
Practice Address - Street 1:500 UNIVERSITY AVE
Practice Address - Street 2:SUITE 111
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-6504
Practice Address - Country:US
Practice Address - Phone:916-929-2526
Practice Address - Fax:916-929-6128
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-28
Last Update Date:2008-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG064347207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G643470Medicare ID - Type Unspecified
CAF02367Medicare UPIN