Provider Demographics
NPI:1427682764
Name:ANGELA A CHANG MD A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:ANGELA A CHANG MD A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-947-5555
Mailing Address - Street 1:13282 COURTLAND TER
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-1823
Mailing Address - Country:US
Mailing Address - Phone:619-947-5555
Mailing Address - Fax:
Practice Address - Street 1:9834 GENESEE AVE STE 112
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1214
Practice Address - Country:US
Practice Address - Phone:858-208-0030
Practice Address - Fax:858-216-1990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-25
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty