Provider Demographics
NPI:1992894885
Name:CHANG, ROBERT (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:CHANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 54130
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90054-0130
Mailing Address - Country:US
Mailing Address - Phone:951-687-3200
Mailing Address - Fax:951-687-8923
Practice Address - Street 1:2057 COMPTON AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92881-7287
Practice Address - Country:US
Practice Address - Phone:951-736-6757
Practice Address - Fax:951-736-0167
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA85088207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A850880Medicaid
CAAN188ZMedicare PIN