Provider Demographics
NPI:1386716413
Name:CHANG, SAE CHAN (MD)
Entity type:Individual
Prefix:
First Name:SAE
Middle Name:CHAN
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 1:3430 SUNSET AVE
Mailing Address - Street 2:SUITE 6A
Mailing Address - City:OCEAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07712-3954
Mailing Address - Country:US
Mailing Address - Phone:732-922-9696
Mailing Address - Fax:732-922-5866
Practice Address - Street 1:3430 SUNSET AVE
Practice Address - Street 2:SUITE 6A
Practice Address - City:OCEAN
Practice Address - State:NJ
Practice Address - Zip Code:07712-3954
Practice Address - Country:US
Practice Address - Phone:732-922-9696
Practice Address - Fax:732-922-5866
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA33063207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0178101Medicaid
NJ439155Medicare ID - Type Unspecified
NJD06373Medicare UPIN