Provider Demographics
NPI:1992877625
Name:CHANG, GRACE H (MD)
Entity type:Individual
Prefix:DR
First Name:GRACE
Middle Name:H
Last Name:CHANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:17875 VON KARMAN AVE STE 430
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-6212
Mailing Address - Country:US
Mailing Address - Phone:949-872-2850
Mailing Address - Fax:949-872-2855
Practice Address - Street 1:17875 VON KARMAN AVE STE 430
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92614-6212
Practice Address - Country:US
Practice Address - Phone:949-872-2850
Practice Address - Fax:949-872-2855
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA61499207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH19164Medicare UPIN