Provider Demographics
NPI:1306959259
Name:CHANG, JOSEPH (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
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:PO BOX 20831
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93390-0831
Mailing Address - Country:US
Mailing Address - Phone:805-565-5700
Mailing Address - Fax:661-335-7766
Practice Address - Street 1:4101 EMPIRE DRIVE
Practice Address - Street 2:SUITE 120
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309
Practice Address - Country:US
Practice Address - Phone:661-325-3934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA65942207W00000X
CAA29218207WX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0200XAllopathic & Osteopathic PhysiciansOphthalmologyOphthalmic Plastic and Reconstructive SurgeryGroup - Single Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOOA659420Medicaid
CAMEDICARE RAILROADOther180040989
CAOOA659420Medicaid
CA00A659420Medicare PIN