Provider Demographics
NPI:1164445896
Name:CHANG, TONY M (MD)
Entity type:Individual
Prefix:DR
First Name:TONY
Middle Name:M
Last Name:CHANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:801 S HAM LN STE E
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95242-7502
Mailing Address - Country:US
Mailing Address - Phone:209-333-1441
Mailing Address - Fax:209-333-1476
Practice Address - Street 1:801 S HAM LN STE E
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95242-7502
Practice Address - Country:US
Practice Address - Phone:209-333-1441
Practice Address - Fax:209-333-1476
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA85797208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery