Provider Demographics
NPI:1538195755
Name:CHANG, GILBERT T (MD)
Entity type:Individual
Prefix:DR
First Name:GILBERT
Middle Name:T
Last Name:CHANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:5140 BUSINESS CENTER DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94534-1793
Mailing Address - Country:US
Mailing Address - Phone:707-864-9999
Mailing Address - Fax:707-864-5376
Practice Address - Street 1:5140 BUSINESS CENTER DR
Practice Address - Street 2:SUITE 200
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94534-1658
Practice Address - Country:US
Practice Address - Phone:707-864-9999
Practice Address - Fax:707-864-5376
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-23
Last Update Date:2009-03-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA70026208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A70026Medicare ID - Type Unspecified