Provider Demographics
NPI:1366411548
Name:CHANG, GARY J (MD)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:J
Last Name:CHANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 3168
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93912-3168
Mailing Address - Country:US
Mailing Address - Phone:831-649-1000
Mailing Address - Fax:831-649-4966
Practice Address - Street 1:12 UPPER RAGSDALE DR
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-5730
Practice Address - Country:US
Practice Address - Phone:831-648-7200
Practice Address - Fax:831-648-7204
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2018-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG48331207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A92810Medicare UPIN
WG48331DMedicare ID - Type Unspecified
CAWG48331EMedicare ID - Type Unspecified
CA00G483310Medicare PIN