Provider Demographics
NPI:1154384311
Name:CHANG, RICHARD S (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:S
Last Name:CHANG
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13236 N 7TH ST STE 4
Mailing Address - Street 2:#504
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85022-5343
Mailing Address - Country:US
Mailing Address - Phone:623-296-2149
Mailing Address - Fax:
Practice Address - Street 1:344 18TH ST
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90402-2406
Practice Address - Country:US
Practice Address - Phone:310-260-8581
Practice Address - Fax:888-960-2154
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA73466207R00000X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00L075240Medicaid
CAP00784478OtherRAILROAD MEDICARE
CA00A734660OtherMEDI-CAL
CAI07524Medicare UPIN
CAAV893ZMedicare PIN
CAWA73466AMedicare PIN
CAAV893PMedicare PIN
CA00L075240Medicaid