Provider Demographics
NPI:1386861409
Name:CHANG, TINYEE TSAI (MD)
Entity type:Individual
Prefix:MRS
First Name:TINYEE
Middle Name:TSAI
Last Name:CHANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TINYEE
Other - Middle Name:L
Other - Last Name:TSAI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2570 GOODWATER AVE
Mailing Address - Street 2:#300
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-1548
Mailing Address - Country:US
Mailing Address - Phone:530-221-3376
Mailing Address - Fax:530-221-3378
Practice Address - Street 1:375 SMILE PLACE SUITE B
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001
Practice Address - Country:US
Practice Address - Phone:530-221-3376
Practice Address - Fax:530-221-3378
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA88191207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGT618AOtherPTAN
CARHM53955FMedicaid
CAGR0089250Medicaid
CARHM53955FMedicaid